Healthcare Provider Details

I. General information

NPI: 1376102343
Provider Name (Legal Business Name): INTEGRATIVE HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 PIONEERS BLVD STE 4
LINCOLN NE
68506-7554
US

IV. Provider business mailing address

5941 QUEENS DR
LINCOLN NE
68516-3136
US

V. Phone/Fax

Practice location:
  • Phone: 785-656-1333
  • Fax:
Mailing address:
  • Phone: 785-656-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. D'LAYNA MARLENE BRENING
Title or Position: OWNER
Credential: APRN
Phone: 785-656-1333