| NPI | 1508171612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW M GLENN Owner 402-421-2100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2012-05-22 |