MEDICARE: THE EXPRESS CLINIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1477759348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EXPRESS CLINIC, LLC

Provider Business Mailing Address
First Line	:	PO BOX 23048
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68542
Country	:	US
Telephone Number	:	402-420-2094
Fax Number	:	402-420-2095

Provider Business Practice Location Address
First Line	:	2525 PINE LAKE RD
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68512-3632
Country	:	US
Telephone Number	:	402-420-2094
Fax Number	:	402-420-2095

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MRS. BETTE GRACE TUCKER
Credential	:	APRN
Telephone Number	:	402-440-1312

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	12/11/2009

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Directions to “THE EXPRESS CLINIC, LLC ” Practice Location

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