Healthcare Provider Details

I. General information

NPI: 1073198545
Provider Name (Legal Business Name): MR. BRENT ALBERT URBAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/16/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13520 COTTNER ST
OMAHA NE
68137-1630
US

IV. Provider business mailing address

13520 COTTNER ST
OMAHA NE
68137-1630
US

V. Phone/Fax

Practice location:
  • Phone: 402-804-8668
  • Fax:
Mailing address:
  • Phone: 402-804-8668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: