Provider Demographics
NPI:1700165743
Name:CHILDRENS PHYSICIANS CLINIC
Entity Type:Organization
Organization Name:CHILDRENS PHYSICIANS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:402-618-1148
Mailing Address - Street 1:16909 Q ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-1521
Mailing Address - Country:US
Mailing Address - Phone:402-955-7575
Mailing Address - Fax:402-955-7555
Practice Address - Street 1:16909 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1521
Practice Address - Country:US
Practice Address - Phone:402-955-7575
Practice Address - Fax:402-955-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111264282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren