Healthcare Provider Details

I. General information

NPI: 1184442782
Provider Name (Legal Business Name): BRENDON MICHAEL PRIBYL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982315 NEBRASKA MEDICAL CTR
OMAHA NE
68198-2315
US

IV. Provider business mailing address

SOUTH 42ND & EMILE ST
OMAHA NE
68198-1502
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number115648
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number115648
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: