Provider Demographics
NPI:1396833224
Name:BROWN, VICKI LYNN (RD, LMNT, CDE)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:RD, LMNT, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84577 534 AVE
Mailing Address - Street 2:
Mailing Address - City:TILDEN
Mailing Address - State:NE
Mailing Address - Zip Code:68781-8033
Mailing Address - Country:US
Mailing Address - Phone:402-368-7857
Mailing Address - Fax:
Practice Address - Street 1:2700 W NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4438
Practice Address - Country:US
Practice Address - Phone:402-644-7513
Practice Address - Fax:402-844-8229
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE630133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE865036OtherCDR
NE710000523Medicare ID - Type UnspecifiedMEDICARE RAILROAD INDIV
NE275518Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
NE865036OtherCDR