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General NPI Number Information
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NPI Number | 1548861594
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Entity Type | Organization
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Legal Business Name | CENTRAL ENDOCRINOLOGY AND WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 215 W 29TH ST STE A
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City | KEARNEY
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State | NE
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Zip | 68845-3474
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Country | US
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Telephone | 308-455-3382
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Fax | 308-455-3382
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Provider Business Mailing Address
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Address Line | 215 W 29TH ST STE A
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City | KEARNEY
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State | NE
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Zip | 68845-3474
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Country | US
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Telephone | 308-455-3382
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Fax | 308-455-3382
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | MILEAH PANTER
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Credential | NP
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Telephone | 308-455-3382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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