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General NPI Number Information
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NPI Number | 1790978583
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Entity Type | Organization
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Legal Business Name | NELIGH CLINIC LLC
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1108 R ST
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City | NELIGH
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State | NE
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Zip | 68756-1022
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Country | US
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Telephone | 402-887-4681
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Fax |
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Provider Business Mailing Address
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Address Line | 1108 R ST
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City | NELIGH
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State | NE
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Zip | 68756-1022
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Country | US
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Telephone | 402-887-4681
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | BRENDA KORTH-WURDINGER
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Credential | PA-C
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Telephone | 402-887-4681
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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 | NE
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