Healthcare Provider Details

I. General information

NPI: 1962838193
Provider Name (Legal Business Name): PLATTE RIVER NEPHROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W FRANCIS ST STE 270
NORTH PLATTE NE
69101-0614
US

IV. Provider business mailing address

611 W FRANCIS ST STE 270
NORTH PLATTE NE
69101-0614
US

V. Phone/Fax

Practice location:
  • Phone: 308-532-3022
  • Fax: 308-532-3335
Mailing address:
  • Phone: 308-532-3022
  • Fax: 308-532-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DONNA SCHMIDT
Title or Position: CREDENTIALING
Credential:
Phone: 317-781-3604