Healthcare Provider Details

I. General information

NPI: 1659754034
Provider Name (Legal Business Name): ELIZABETH NICOLE BRONSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114-4113
US

IV. Provider business mailing address

4708 N 167TH AVE
OMAHA NE
68116-8062
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-8065
  • Fax: 402-955-3398
Mailing address:
  • Phone: 402-669-2919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number111937
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: