Healthcare Provider Details

I. General information

NPI: 1427640630
Provider Name (Legal Business Name): BRANDY WHITMORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 SOUTH ST STE 110
LINCOLN NE
68502-2467
US

IV. Provider business mailing address

1430 SOUTH ST STE 110
LINCOLN NE
68502-2467
US

V. Phone/Fax

Practice location:
  • Phone: 531-500-4429
  • Fax:
Mailing address:
  • Phone: 531-500-4429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number75597
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: