Provider Demographics
NPI:1548018021
Name:TRAIL CITY WELLNESS LLC
Entity type:Organization
Organization Name:TRAIL CITY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP, APRN, PMHNP-BC
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:308-672-1907
Mailing Address - Street 1:PO BOX 1083
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:NE
Mailing Address - Zip Code:69336-1083
Mailing Address - Country:US
Mailing Address - Phone:308-672-1907
Mailing Address - Fax:
Practice Address - Street 1:1015 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:NE
Practice Address - Zip Code:69336-4057
Practice Address - Country:US
Practice Address - Phone:308-672-1907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)