Healthcare Provider Details

I. General information

NPI: 1730798554
Provider Name (Legal Business Name): KELLI JANENE BRIGMAN REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 DEWEY AVE
OMAHA NE
68105-1017
US

IV. Provider business mailing address

15811 COTTONWOOD ST
OMAHA NE
68136-3215
US

V. Phone/Fax

Practice location:
  • Phone: 800-922-0000
  • Fax:
Mailing address:
  • Phone: 402-995-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number77830
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: