Individual
MR. EDISON MICHAEL RED NEST III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
217 BOX BUTTE AVE, ALLIANCE, NE 69301-3741
(308) 458-7795
Mailing address
217 BOX BUTTE AVENUE, ALLIANCE, NE 69301
(308) 458-7795
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
05/09/2014
Last updated
05/09/2014
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