| NPI | 1497091888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI RAE PAVLISH Nurse Practitioner 402-525-6976 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: NE 111265) |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2024-04-24 |