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General NPI Number Information
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NPI Number | 1710203054
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Entity Type | Organization
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Legal Business Name | HASTINGS CONVENIENT CARE PC
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 208 S BURLINGTON AVE STE. 108
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City | HASTINGS
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State | NE
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Zip | 68901-5904
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Country | US
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Telephone | 402-463-6300
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Fax | 402-834-0665
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Provider Business Mailing Address
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Address Line | 208 S BURLINGTON AVE STE. 108
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City | HASTINGS
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State | NE
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Zip | 68901-5904
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Country | US
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Telephone | 402-463-6300
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Fax | 402-834-0665
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Authorized Official
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Title or Position | CO-OWNER
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Name | ANDREA D CLEMENT
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Credential | PA-C
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Telephone | 402-463-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 110737
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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