Healthcare Provider Details

I. General information

NPI: 1124502885
Provider Name (Legal Business Name): KATRINA MARIE BRENN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 S SYCAMORE ST
BLUE HILL NE
68930-3535
US

IV. Provider business mailing address

PO BOX 284
BLUE HILL NE
68930-0284
US

V. Phone/Fax

Practice location:
  • Phone: 402-756-2085
  • Fax:
Mailing address:
  • Phone: 402-469-2297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number66927
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: