Provider Demographics
NPI:1679047955
Name:NEBRASKA HEALTH AND WELLNESS CLINIC LLC
Entity type:Organization
Organization Name:NEBRASKA HEALTH AND WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:NUNO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:402-315-7538
Mailing Address - Street 1:1112 VERGES AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3853
Mailing Address - Country:US
Mailing Address - Phone:402-379-8727
Mailing Address - Fax:402-379-0447
Practice Address - Street 1:1112 VERGES AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3853
Practice Address - Country:US
Practice Address - Phone:402-315-7538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-19
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty