Provider Demographics
NPI:1841822590
Name:PROSPERITY HEALTH AND WELLNESS CLINIC
Entity type:Organization
Organization Name:PROSPERITY HEALTH AND WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:308-227-6110
Mailing Address - Street 1:403 LEXINGTON CIR STE I
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-9728
Mailing Address - Country:US
Mailing Address - Phone:309-227-6119
Mailing Address - Fax:308-888-0018
Practice Address - Street 1:403 LEXINGTON CIR STE I
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-9728
Practice Address - Country:US
Practice Address - Phone:309-227-6119
Practice Address - Fax:308-888-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty