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General NPI Number Information
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NPI Number | 1417871518
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Entity Type | Organization
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Legal Business Name | GENERATION CLINICAL PARTNERS LLC
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Dates
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Enumeration Date | 08/10/2026
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Last Update Date | 08/10/2026
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Provider Practice Location Address
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Address Line | 1400 MARK DR
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City | WAHOO
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State | NE
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Zip | 68066-4023
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Country | US
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Telephone | 314-925-0903
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Fax |
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Provider Business Mailing Address
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Address Line | 10426 BAUR BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63132-1905
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OF OPERATIONS
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Name | MAE LIN
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Credential |
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Telephone | 314-925-0903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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