| NPI | 1811982549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANNA J BROUILLETTE General Manager 308-532-4700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: NE 28D0456332) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: NE 15625) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: NE 15625) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2023-06-26 |