Provider Demographics
NPI:1043510803
Name:NELSON, BRENDA
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N 5TH ST
Mailing Address - Street 2:P. O. BOX 147
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-1565
Mailing Address - Country:US
Mailing Address - Phone:402-336-4841
Mailing Address - Fax:402-336-4640
Practice Address - Street 1:118 N 5TH ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1565
Practice Address - Country:US
Practice Address - Phone:402-336-4841
Practice Address - Fax:402-336-4640
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health