Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 112178 | NE |
NPI | 1033656004 |
---|---|
Provider Name | Jill K Brandl |
First Address | Lincoln, NE 68502-3700 |
Second Address | Lincoln, NE 68502-3700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2017 |
Last Update Date | 02/02/2017 |