Healthcare Provider Details

I. General information

NPI: 1477422293
Provider Name (Legal Business Name): LAUREN BRANDQUIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9239 W CENTER RD STE 100
OMAHA NE
68124-1900
US

IV. Provider business mailing address

16316 WHITMORE ST
BENNINGTON NE
68007-3337
US

V. Phone/Fax

Practice location:
  • Phone: 402-399-8888
  • Fax:
Mailing address:
  • Phone: 402-764-0141
  • Fax: 402-764-0141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number97689
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: