Healthcare Provider Details

I. General information

NPI: 1245438167
Provider Name (Legal Business Name): MICHELLE K BRESTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. MICHELLE K WALL

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDREN'S HOSPITAL - ANESTHESIOLOGY 8200 DODGE STREET
OMAHA NE
68114-4113
US

IV. Provider business mailing address

CHILDREN'S HOSPITAL 8200 DODGE STREET
OMAHA NE
68114-4113
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-4303
  • Fax: 402-955-4300
Mailing address:
  • Phone: 402-955-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110547
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: