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General NPI Number Information
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NPI Number | 1467985820
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Entity Type | Organization
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Legal Business Name | NU TRANSFORMATIVE CARE CLINIC LLC
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 08/02/2017
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Provider Practice Location Address
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Address Line | 8 W 56TH ST SUITE A-3
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City | KEARNEY
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State | NE
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Zip | 68847-0505
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Country | US
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Telephone | 308-455-3111
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Fax | 308-455-3058
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Provider Business Mailing Address
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Address Line | 8 W 56TH ST SUITE A-3
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City | KEARNEY
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State | NE
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Zip | 68847-0505
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Country | US
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Telephone | 308-455-3111
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Fax | 308-455-3058
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | YVETTE MARIE FENSLER
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Credential | APRN, FNP-C
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Telephone | 308-455-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 112055
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License Number State | NE
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