Provider Demographics
NPI:1124549860
Name:BRUHN, NICHOLLE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:NICHOLLE
Middle Name:
Last Name:BRUHN
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19102 Q ST STE 102
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-1558
Mailing Address - Country:US
Mailing Address - Phone:402-330-5690
Mailing Address - Fax:
Practice Address - Street 1:19102 Q ST STE 102
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1558
Practice Address - Country:US
Practice Address - Phone:402-330-5690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112239363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics