Healthcare Provider Details

I. General information

NPI: 1881284966
Provider Name (Legal Business Name): SHELBY E BRUENING PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7121 STEPHANIE LN STE 102
LINCOLN NE
68516-5352
US

IV. Provider business mailing address

7121 STEPHANIE LN STE 102
LINCOLN NE
68516-5352
US

V. Phone/Fax

Practice location:
  • Phone: 402-413-5010
  • Fax: 402-413-5009
Mailing address:
  • Phone: 970-663-2742
  • Fax: 970-667-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2576
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: