| NPI | 1922746502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATRICE D. MARTIN Owner 402-312-3261 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2024-05-23 |