Healthcare Provider Details

I. General information

NPI: 1225418031
Provider Name (Legal Business Name): ERIN RENEE BRUMMETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N 103RD PLZ SUITE 102
OMAHA NE
68114-1114
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-0120
  • Fax: 402-354-0125
Mailing address:
  • Phone: 402-354-2100
  • Fax: 402-354-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111803
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: