Healthcare Provider Details

I. General information

NPI: 1366097610
Provider Name (Legal Business Name): RACHAEL NICOLE BRUECHERT RN, BSN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHAEL NICOLE COUFAL

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E 23RD ST
FREMONT NE
68025-2303
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 402-721-1610
  • Fax:
Mailing address:
  • Phone: 402-354-2100
  • Fax: 402-354-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number112868
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: