Healthcare Provider Details

I. General information

NPI: 1295884526
Provider Name (Legal Business Name): JAINE BROWNELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16945 FRANCES ST
OMAHA NE
68130-2312
US

IV. Provider business mailing address

8709 ARBOR ST
OMAHA NE
68124-2123
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-7400
  • Fax: 402-397-0115
Mailing address:
  • Phone: 402-397-8309
  • Fax: 402-397-8309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number22154
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: