Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | H154470 | IA |
N | 363LG0600X | Nurse Practitioner - Gerontology | H154470 | IA |
NPI | 1013572486 |
---|---|
Provider Name | Mrs. Dawnette Lynn Bredberg |
First Address | Tabor, IA 51653-2041 |
Second Address | Omaha, NE 68105-1850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2019 |
Last Update Date | 01/05/2019 |