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NPI Code Detail

MEDICARE: MRS. KRISTEN ALYCE BRUENING PA-C

MEDICARE: MRS. KRISTEN ALYCE BRUENING PA-C
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
1363A00000XPhysician Assistant1451NE

General Provider Information

NPI Number : 1609103415
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTEN ALYCE BRUENING PA-C
Provider Business Mailing Address
First Line : 8550 CUTHILLS CIR
Second Line :
City : LINCOLN
State : NE
Zip : 68526-9474
Country : US
Telephone Number : 402-466-3355
Fax Number :
Provider Business Practice Location Address
First Line : 8550 CUTHILLS CIR
Second Line :
City : LINCOLN
State : NE
Zip : 68526-9474
Country : US
Telephone Number : 402-466-3355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2009
Last Update Date : 03/04/2020

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