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General NPI Number Information
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NPI Number | 1700691862
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Entity Type | Organization
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Legal Business Name | THRIVE AND GROW MEDICAL LLC
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 7435 LEAWOOD ST
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City | PAPILLION
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State | NE
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Zip | 68046-4227
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Country | US
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Telephone | 505-850-2544
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Fax |
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Provider Business Mailing Address
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Address Line | 7435 LEAWOOD ST
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City | PAPILLION
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State | NE
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Zip | 68046-4227
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Country | US
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Telephone | 505-850-2544
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LESLIE DVORAK
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Credential | APRN
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Telephone | 505-850-2544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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