MEDICARE: BREE-ANN HERMOSILLO RN

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	364SP2800X	Perioperative Clinical Nurse Specialist	171112	IA

General Provider Information

NPI Number	:	1275475881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREE-ANN HERMOSILLO RN

Provider Business Mailing Address
First Line	:	4101 WOOLWORTH AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68105-1850
Country	:	US
Telephone Number	:	402-995-5572
Fax Number	:	402-995-5583

Provider Business Practice Location Address
First Line	:	4101 WOOLWORTH AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68105-1850
Country	:	US
Telephone Number	:	402-995-5572
Fax Number	:	402-995-5583

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

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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