| NPI | 1730466228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANDRA LYNN WILKINS Operations Manager 402-881-0081 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 171W00000X Contractor |
| 207Q00000X Family Medicine | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2014-10-06 |