Provider Demographics
NPI:1225366388
Name:DIABETES AND WELLNESS CLINIC LLC
Entity Type:Organization
Organization Name:DIABETES AND WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIABETES NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRTEK ZWIENER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-379-9600
Mailing Address - Street 1:809 1/2 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5753
Mailing Address - Country:US
Mailing Address - Phone:402-379-9600
Mailing Address - Fax:402-379-9601
Practice Address - Street 1:809 1/2 S 13TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5753
Practice Address - Country:US
Practice Address - Phone:402-379-9600
Practice Address - Fax:402-379-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110697261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care