Provider Demographics
NPI:1548861594
Name:CENTRAL ENDOCRINOLOGY AND WELLNESS CLINIC LLC
Entity type:Organization
Organization Name:CENTRAL ENDOCRINOLOGY AND WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:308-455-3382
Mailing Address - Street 1:215 W 29TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-3474
Mailing Address - Country:US
Mailing Address - Phone:308-455-3382
Mailing Address - Fax:308-455-3382
Practice Address - Street 1:215 W 29TH ST STE A
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-3474
Practice Address - Country:US
Practice Address - Phone:308-455-3382
Practice Address - Fax:308-455-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty