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NPI Code Detail

MEDICARE: NICOLE RAE BROCK CNA,

MEDICARE: NICOLE RAE BROCK CNA,
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
1376K00000XNurse's Aide
2374U00000XHome Health Aide

General Provider Information

NPI Number : 1578363149
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE RAE BROCK CNA,
Provider Business Mailing Address
First Line : 2416 NW 50TH ST
Second Line :
City : LINCOLN
State : NE
Zip : 68524-1538
Country : US
Telephone Number : 402-480-3031
Fax Number :
Provider Business Practice Location Address
First Line : 390 N COTNER BLVD
Second Line :
City : LINCOLN
State : NE
Zip : 68505-2371
Country : US
Telephone Number : 402-287-6171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2025
Last Update Date : 03/13/2025

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Directions to “ NICOLE RAE BROCK CNA,” Practice Location

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