Grandgen, LLC

NPI #1326351651 in Omaha, Nebraska

Provider Information

NPI Number: 1326351651
Entity Type: Organization
Organization Name: Grandgen, LLC
Primary Specialty: Specialist
Enumeration Date: Jul 15, 2010
Last Updated: Jul 15, 2010

Practice Location

Address: 9802 NICHOLAS ST
Address 2: SUITE 305
City: Omaha
State: Nebraska
ZIP Code: 68114-2167
Phone: (402) 397-2300

Authorized Official

Name: MR. JON FULCHER
Title: PRESIDENT
Phone: (402) 445-6173

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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