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General NPI Number Information
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NPI Number | 1679047955
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Entity Type | Organization
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Legal Business Name | NEBRASKA HEALTH AND WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 01/19/2019
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 1112 VERGES AVE
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City | NORFOLK
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State | NE
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Zip | 68701-3853
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Country | US
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Telephone | 402-315-7538
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 VERGES AVE
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City | NORFOLK
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State | NE
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Zip | 68701-3853
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Country | US
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Telephone | 402-379-8727
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Fax | 402-379-0447
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Authorized Official
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Title or Position | OWNER
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Name | JOSE LUIS NUNO
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Credential | PA-C
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Telephone | 402-315-7538
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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