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General NPI Number Information
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NPI Number | 1740679463
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Entity Type | Organization
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Legal Business Name | GENESIS PSYCHIATRIC GROUP, LLC
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Dates
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Enumeration Date | 01/19/2015
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Last Update Date | 02/19/2015
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Provider Practice Location Address
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Address Line | 2130 S 17TH ST STE 100
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City | LINCOLN
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State | NE
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Zip | 68502-3750
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Country | US
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Telephone | 402-540-6365
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 PERKINS BLVD
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City | LINCOLN
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State | NE
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Zip | 68502-3934
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE LEMON
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Credential | APRN
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Telephone | 402-540-6365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 965
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 110205
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License Number State | NE
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