Provider Demographics
NPI:1942195797
Name:AM WELLNESS CLINIC LLC
Entity type:Organization
Organization Name:AM WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:MALCOLM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:308-778-6468
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:NE
Mailing Address - Zip Code:69336-0147
Mailing Address - Country:US
Mailing Address - Phone:308-262-5640
Mailing Address - Fax:970-667-0847
Practice Address - Street 1:1002 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:NE
Practice Address - Zip Code:69336-4035
Practice Address - Country:US
Practice Address - Phone:308-262-5640
Practice Address - Fax:970-667-0847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty