Provider Demographics
NPI:1558828806
Name:BROKAW, MEGAN BETH (RN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:BETH
Last Name:BROKAW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:BETH
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1320 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:NE
Mailing Address - Zip Code:68649-5016
Mailing Address - Country:US
Mailing Address - Phone:402-652-3268
Mailing Address - Fax:402-652-8348
Practice Address - Street 1:1320 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:NE
Practice Address - Zip Code:68649-5016
Practice Address - Country:US
Practice Address - Phone:402-652-3268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE74114163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool