Healthcare Provider Details

I. General information

NPI: 1770045536
Provider Name (Legal Business Name): JAMES BRUCE WHITE II FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 HARLAN DR
BELLEVUE NE
68005-3699
US

IV. Provider business mailing address

4820 SOUTH 30 TH STREET
OMAHA NE
68107
US

V. Phone/Fax

Practice location:
  • Phone: 22-918-7014
  • Fax: 402-291-8702
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA157340
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number112769
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: