Healthcare Provider Details

I. General information

NPI: 1528212438
Provider Name (Legal Business Name): NEBRASKA MYOFUNCTIONAL SPECIALTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 02/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8911 WHISPERING WIND RD
LINCOLN NE
68512-9278
US

IV. Provider business mailing address

8911 WHISPERING WIND RD
LINCOLN NE
68512-9278
US

V. Phone/Fax

Practice location:
  • Phone: 402-759-1762
  • Fax:
Mailing address:
  • Phone: 402-759-1762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number67
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number613
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA LYNN BRINKMAN-FALTER
Title or Position: CERTIFIED OROFACIAL MYOLOGIST
Credential: PHRDH, BSDH, MS, COM
Phone: 402-759-1762