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General NPI Number Information
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NPI Number | 1578363149
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Entity Type | Individual
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Provider Name | NICOLE RAE BROCK CNA,
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Gender | Female
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 390 N COTNER BLVD
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City | LINCOLN
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State | NE
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Zip | 68505-2371
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Country | US
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Telephone | 402-287-6171
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Fax |
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Provider Business Mailing Address
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Address Line | 2416 NW 50TH ST
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City | LINCOLN
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State | NE
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Zip | 68524-1538
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Country | US
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Telephone | 402-480-3031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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