MEDICARE: NANCY D BREDENKAMP 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	110598	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01597	OTHER	NE	BLUE CROSS BLUE SHIELD NE

General Provider Information

NPI Number	:	1811999501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY D BREDENKAMP APRN

Provider Business Mailing Address
First Line	:	102 N PINE ST
Second Line	:	BLUE HILL CLINIC-MLMH
City	:	BLUE HILL
State	:	NE
Zip	:	68930-5532
Country	:	US
Telephone Number	:	402-756-2141
Fax Number	:	402-756-2142

Provider Business Practice Location Address
First Line	:	102 N PINE ST
Second Line	:	BLUE HILL CLINIC-MLMH
City	:	BLUE HILL
State	:	NE
Zip	:	68930-5532
Country	:	US
Telephone Number	:	402-756-2141
Fax Number	:	402-756-2142

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	09/30/2010

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