MEDICARE: ROBERT J BROEKEMEIER APRN

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	363LF0000X	Family Nurse Practitioner	111112	NE

General Provider Information

NPI Number	:	1730410069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J BROEKEMEIER APRN

Provider Business Mailing Address
First Line	:	503 N. 6TH ST.
Second Line	:
City	:	PIERCE
State	:	NE
Zip	:	68767-1019
Country	:	US
Telephone Number	:	402-329-6780
Fax Number	:	605-668-8605

Provider Business Practice Location Address
First Line	:	503 N 6TH ST
Second Line	:
City	:	PIERCE
State	:	NE
Zip	:	68767-1019
Country	:	US
Telephone Number	:	402-329-6780
Fax Number	:	605-668-8605

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

Provider Enumeration Date	:	01/27/2010
Last Update Date	:	01/27/2010

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