Provider Demographics
NPI:1942907399
Name:TD NURSE PRACTITIONER SERVICES, LLC
Entity Type:Organization
Organization Name:TD NURSE PRACTITIONER SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANN-ROTH
Authorized Official - Last Name:DOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:402-641-8822
Mailing Address - Street 1:4972 COUNTY ROAD 38
Mailing Address - Street 2:
Mailing Address - City:FORT CALHOUN
Mailing Address - State:NE
Mailing Address - Zip Code:68023-5054
Mailing Address - Country:US
Mailing Address - Phone:402-641-8822
Mailing Address - Fax:
Practice Address - Street 1:4972 COUNTY ROAD 38
Practice Address - Street 2:
Practice Address - City:FORT CALHOUN
Practice Address - State:NE
Practice Address - Zip Code:68023-5054
Practice Address - Country:US
Practice Address - Phone:402-641-8822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10027821400Medicaid