Healthcare Provider Details

I. General information

NPI: 1801187356
Provider Name (Legal Business Name): FAMILY FIRST HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MAPLE ST STE 105
SUTHERLAND NE
69165-0218
US

IV. Provider business mailing address

333 MAPLE ST STE 105 PO BOX 218
SUTHERLAND NE
69165-0218
US

V. Phone/Fax

Practice location:
  • Phone: 308-386-4799
  • Fax: 308-386-4343
Mailing address:
  • Phone: 308-386-4799
  • Fax: 308-386-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FAYLENE DANCER
Title or Position: OWNER
Credential: APRN
Phone: 308-386-4799