Healthcare Provider Details

I. General information

NPI: 1184423956
Provider Name (Legal Business Name): BRIANNA JOY RERUCHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 41 RD
BELLWOOD NE
68624-2488
US

IV. Provider business mailing address

2316 9TH ST
COLUMBUS NE
68601-5704
US

V. Phone/Fax

Practice location:
  • Phone: 402-285-2485
  • Fax: 402-562-8774
Mailing address:
  • Phone: 402-562-6492
  • Fax: 402-562-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: