Healthcare Provider Details

I. General information

NPI: 1154997732
Provider Name (Legal Business Name): BRIANNA NICOLE CUMMINGS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA NICOLE DIERKS PA-C

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S 48TH ST
LINCOLN NE
68506-1283
US

IV. Provider business mailing address

2300 S 16TH ST
LINCOLN NE
68502-3704
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-8566
  • Fax:
Mailing address:
  • Phone: 402-481-8566
  • Fax: 402-481-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2618
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2618
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2618
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: