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General NPI Number Information
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NPI Number | 1134616212
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Entity Type | Organization
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Legal Business Name | ADVANCED MOBILE MEDICINE LLC
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Dates
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Enumeration Date | 04/15/2018
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 1902 HARLAN DR
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City | BELLEVUE
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State | NE
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Zip | 68005-6602
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Country | US
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Telephone | 402-934-3886
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Fax |
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Provider Business Mailing Address
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Address Line | 1902 HARLAN DR
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City | BELLEVUE
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State | NE
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Zip | 68005-6602
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Country | US
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Telephone | 402-934-3886
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | REGGIE RIPPLE
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Credential |
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Telephone | 402-934-2356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 111120
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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