Healthcare Provider Details

I. General information

NPI: 1457283459
Provider Name (Legal Business Name): BRENDA L LEWIS BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11420 BLONDO ST
OMAHA NE
68164-3857
US

IV. Provider business mailing address

PO BOX 939
BELLEVUE NE
68005-0939
US

V. Phone/Fax

Practice location:
  • Phone: 402-933-0680
  • Fax:
Mailing address:
  • Phone: 402-933-0680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number75356
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: