Provider Demographics
NPI:1013967447
Name:HENSLEY, BRANDI L (PA)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:L
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:L
Other - Last Name:LESIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:985578 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-4108
Mailing Address - Country:US
Mailing Address - Phone:402-552-6007
Mailing Address - Fax:402-552-6035
Practice Address - Street 1:985578 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-4108
Practice Address - Country:US
Practice Address - Phone:402-552-6007
Practice Address - Fax:402-552-6035
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE787363A00000X
CT002763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE275951Medicare ID - Type Unspecified
NES54752Medicare UPIN