MEDICARE: JILL K BRANDL PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	112178	NE

General Provider Information

NPI Number	:	1033656004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL K BRANDL PMHNP-BC

Provider Business Mailing Address
First Line	:	2221 S 17TH ST
Second Line	:	SUITE 202
City	:	LINCOLN
State	:	NE
Zip	:	68502-3700
Country	:	US
Telephone Number	:	402-483-8555
Fax Number	:	402-483-8554

Provider Business Practice Location Address
First Line	:	2221 S 17TH ST
Second Line	:	SUITE 202
City	:	LINCOLN
State	:	NE
Zip	:	68502-3700
Country	:	US
Telephone Number	:	402-483-8555
Fax Number	:	402-483-8554

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2017
Last Update Date	:	02/02/2017

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