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General NPI Number Information
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NPI Number | 1477066421
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Entity Type | Organization
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Legal Business Name | REAL LIFE HEALTH, LLC
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 11/13/2017
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Provider Practice Location Address
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Address Line | 705 N 17TH AVE
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City | ASHLAND
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State | NE
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Zip | 68003-1209
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Country | US
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Telephone | 402-944-8112
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Fax | 866-354-4020
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Provider Business Mailing Address
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Address Line | 163 COUNTY ROAD 7
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City | ASHLAND
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State | NE
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Zip | 68003-1173
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Country | US
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Telephone | 402-944-8112
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Fax | 866-354-4020
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | MS. KRISTINA L SMITH
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Credential | APRN
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Telephone | 402-944-8112
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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 | 111990
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License Number State | NE
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