Provider Demographics
NPI:1700691862
Name:THRIVE AND GROW MEDICAL LLC
Entity type:Organization
Organization Name:THRIVE AND GROW MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DVORAK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:505-850-2544
Mailing Address - Street 1:7435 LEAWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4227
Mailing Address - Country:US
Mailing Address - Phone:505-850-2544
Mailing Address - Fax:
Practice Address - Street 1:7435 LEAWOOD ST
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4227
Practice Address - Country:US
Practice Address - Phone:505-850-2544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty