Provider Demographics
NPI:1184150591
Name:BIRD, BRANDY RAE (RN)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:RAE
Last Name:BIRD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:RAE
Other - Last Name:WEMHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:MOSAIC 4980 SOUTH 118TH STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2200
Mailing Address - Country:US
Mailing Address - Phone:402-896-3884
Mailing Address - Fax:402-896-8751
Practice Address - Street 1:MOSAIC MSU 2905 WEST 5TH STREET
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803
Practice Address - Country:US
Practice Address - Phone:308-381-4853
Practice Address - Fax:308-381-4852
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE73739163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse