Healthcare Provider Details

I. General information

NPI: 1275143877
Provider Name (Legal Business Name): NEW BRAIN FRONTIER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 O ST STE 120
LINCOLN NE
68510-2647
US

IV. Provider business mailing address

7441 O ST STE 104
LINCOLN NE
68510-2468
US

V. Phone/Fax

Practice location:
  • Phone: 402-853-0993
  • Fax: 402-853-0197
Mailing address:
  • Phone: 402-853-0993
  • Fax: 402-853-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANA DELGADO
Title or Position: OWNER
Credential:
Phone: 402-853-0993