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General NPI Number Information
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NPI Number | 1558243097
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Entity Type | Organization
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Legal Business Name | HERSTAGE WELLNESS LLC
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 8301 CODY DR
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City | LINCOLN
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State | NE
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Zip | 68512-3759
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Country | US
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Telephone | 402-890-3537
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Fax |
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Provider Business Mailing Address
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Address Line | 6700 BLUE RIDGE LN
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City | LINCOLN
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State | NE
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Zip | 68516-5466
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Country | US
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Telephone | 402-890-3537
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | ANASTASIA GRENFELL
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Credential |
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Telephone | 402-890-3537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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