Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 112860 | NE |
NPI | 1174183644 |
---|---|
Provider Name | Brittany M Wacker |
First Address | Lincoln, NE 68522-4411 |
Second Address | Lincoln, NE 68506-1283 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2019 |
Last Update Date | 09/07/2019 |