Provider Demographics
NPI:1770113854
Name:PRAIRIE PSYCHIATRIC LLC
Entity type:Organization
Organization Name:PRAIRIE PSYCHIATRIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:402-856-0034
Mailing Address - Street 1:8101 O ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2647
Mailing Address - Country:US
Mailing Address - Phone:402-856-0034
Mailing Address - Fax:888-959-0716
Practice Address - Street 1:8101 O ST STE 300
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2647
Practice Address - Country:US
Practice Address - Phone:402-856-0034
Practice Address - Fax:888-959-0716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty