Healthcare Provider Details

I. General information

NPI: 1053129783
Provider Name (Legal Business Name): MRS. BREANNA KAE BEDNARZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BREANNA KAE PATIENT

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 12/27/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 W 38TH DR APT 2
KEARNEY NE
68845-2274
US

IV. Provider business mailing address

1924 W 38TH DR APT 2
KEARNEY NE
68845-2274
US

V. Phone/Fax

Practice location:
  • Phone: 308-233-1058
  • Fax:
Mailing address:
  • Phone: 308-233-1058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: