Provider Demographics
NPI:1598024804
Name:BROOKS, HEIDI L (MSN-RN; APRN-FNP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MSN-RN; APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2797
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-2797
Mailing Address - Country:US
Mailing Address - Phone:402-354-4230
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:8303 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4108
Practice Address - Country:US
Practice Address - Phone:402-354-4001
Practice Address - Fax:402-354-4010
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111302363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470376604-32Medicaid
NE100262035-00Medicaid
NE1598024804OtherWELLMARK
NE100262036-00Medicaid
IA1598024804Medicaid
IA1598024804Medicaid