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General NPI Number Information
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NPI Number | 1225366388
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Entity Type | Organization
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Legal Business Name | DIABETES AND WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 12/01/2009
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Last Update Date | 01/04/2010
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Provider Practice Location Address
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Address Line | 809 1/2 S 13TH ST
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City | NORFOLK
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State | NE
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Zip | 68701-5753
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Country | US
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Telephone | 402-379-9600
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Fax | 402-379-9601
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Provider Business Mailing Address
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Address Line | 809 1/2 S 13TH ST
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City | NORFOLK
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State | NE
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Zip | 68701-5753
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Country | US
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Telephone | 402-379-9600
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Fax | 402-379-9601
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Authorized Official
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Title or Position | OWNER/DIABETES NURSE PRACTITIONER
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Name | MICHELLE D BRTEK ZWIENER
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Credential | APRN
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Telephone | 402-379-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 110697
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License Number State | NE
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