Pine Lake Health LLC

NPI #1780814475 in Waverly, Nebraska

Provider Information

NPI Number: 1780814475
Entity Type: Organization
Organization Name: Pine Lake Health LLC
Subpart: Yes (part of a larger organization)
Parent Organization: PINE LAKE HEALTH, LLC
Primary Specialty: Family Medicine
Enumeration Date: Jul 16, 2009
Last Updated: Aug 30, 2022

Practice Location

Address: 13220 CALLUM DR
Address 2: STE 4
City: Waverly
State: Nebraska
ZIP Code: 68462-2561
Phone: (402) 786-5563

Authorized Official

Name: DR. MATTHEW M GLENN, MD
Title: PHYSICIAN
Phone: (402) 423-4200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X
Nurse Practitioner	363L00000X
Family Medicine	207Q00000X	Primary

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