Healthcare Provider Details

I. General information

NPI: 1861974545
Provider Name (Legal Business Name): WHITNEY BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 O ST
LINCOLN NE
68510-2235
US

IV. Provider business mailing address

601 R ST APT 222
LINCOLN NE
68508-1341
US

V. Phone/Fax

Practice location:
  • Phone: 308-530-1805
  • Fax:
Mailing address:
  • Phone: 308-530-1805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number7194
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: