Provider Demographics
NPI:1689784134
Name:BROCKMAN, KATHLEEN K (RD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:K
Last Name:BROCKMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:K
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:8136 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2614
Mailing Address - Country:US
Mailing Address - Phone:402-488-4771
Mailing Address - Fax:
Practice Address - Street 1:555 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2462
Practice Address - Country:US
Practice Address - Phone:402-219-7363
Practice Address - Fax:402-219-8986
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE109133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered