MEDICARE: BRANDY S. REINEKE P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	1226	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38587	OTHER	NE	BCBS OF NEBRASKA

General Provider Information

NPI Number	:	1093704926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDY S. REINEKE P.A.

Provider Business Mailing Address
First Line	:	8920 FREMONT ST APT 225
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68507-2290
Country	:	US
Telephone Number	:	402-202-1397
Fax Number	:

Provider Business Practice Location Address
First Line	:	6360 JOHN J PERSHING DR FL 2
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68110-1100
Country	:	US
Telephone Number	:	402-935-8100
Fax Number	:	402-935-8101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	09/25/2023

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