Healthcare Provider Details

I. General information

NPI: 1043370794
Provider Name (Legal Business Name): KATHRYN JANE BRAND APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N 162ND AVE SUITE # 301
OMAHA NE
68118-2539
US

IV. Provider business mailing address

PO BOX 2797
OMAHA NE
68103-2797
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-7320
  • Fax: 402-354-7325
Mailing address:
  • Phone: 402-354-4230
  • Fax: 402-354-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110808
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-118307
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: