Healthcare Provider Details

I. General information

NPI: 1215406830
Provider Name (Legal Business Name): BRADY IHNEN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 AMES AVE
OMAHA NE
68111-2431
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 600
NASHVILLE TN
37205-5250
US

V. Phone/Fax

Practice location:
  • Phone: 531-895-7801
  • Fax: 531-895-4013
Mailing address:
  • Phone: 888-987-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1283
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number090097
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2868
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: