Healthcare Provider Details

I. General information

NPI: 1295785525
Provider Name (Legal Business Name): BRIAN JEAN HERBIN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 S 13TH ST
LINCOLN NE
68512-9371
US

IV. Provider business mailing address

2455 PINE LAKE RD STE 110
LINCOLN NE
68512-3665
US

V. Phone/Fax

Practice location:
  • Phone: 402-423-1111
  • Fax: 402-423-0365
Mailing address:
  • Phone: 402-423-1111
  • Fax: 402-423-0365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1038
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1038
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1038
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number1038
License Number StateNE
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number1038
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: