Provider Demographics
NPI:1013572486
Name:BREDBERG, DAWNETTE LYNN (A-GPCNP, APRN)
Entity Type:Individual
Prefix:MRS
First Name:DAWNETTE
Middle Name:LYNN
Last Name:BREDBERG
Suffix:
Gender:F
Credentials:A-GPCNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:TABOR
Mailing Address - State:IA
Mailing Address - Zip Code:51653-2041
Mailing Address - Country:US
Mailing Address - Phone:712-520-1022
Mailing Address - Fax:
Practice Address - Street 1:4101 WOOLWORTH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1850
Practice Address - Country:US
Practice Address - Phone:402-995-5783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH154470363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology