Healthcare Provider Details

I. General information

NPI: 1336675693
Provider Name (Legal Business Name): KAREN BRUENING LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E NORFOLK AVE STE 200
NORFOLK NE
68701-5323
US

IV. Provider business mailing address

109 N 12TH ST
NORFOLK NE
68701-3809
US

V. Phone/Fax

Practice location:
  • Phone: 402-379-3888
  • Fax: 402-379-8478
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number19873
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: