Healthcare Provider Details

I. General information

NPI: 1013572486
Provider Name (Legal Business Name): DAWNETTE LYNN BREDBERG A-GPCNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WOOLWORTH AVE
OMAHA NE
68105-1850
US

IV. Provider business mailing address

211 JACKSON BLVD
TABOR IA
51653-2041
US

V. Phone/Fax

Practice location:
  • Phone: 402-995-5783
  • Fax:
Mailing address:
  • Phone: 712-520-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberH154470
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberH154470
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: