| NPI | 1679007249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA SENANAYAKA Clinic Credentialing Contact 402-350-7616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2023-07-17 |