Provider Demographics
NPI:1033656004
Name:BRANDL, JILL K (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:K
Last Name:BRANDL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 S 17TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3700
Mailing Address - Country:US
Mailing Address - Phone:402-483-8555
Mailing Address - Fax:402-483-8554
Practice Address - Street 1:2221 S 17TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3700
Practice Address - Country:US
Practice Address - Phone:402-483-8555
Practice Address - Fax:402-483-8554
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112178363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health