Provider Demographics
NPI:1295293801
Name:BRASE, ANGELA KARA (RN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:KARA
Last Name:BRASE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2369 ROAD 5000
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:NE
Mailing Address - Zip Code:68335-9442
Mailing Address - Country:US
Mailing Address - Phone:402-364-2496
Mailing Address - Fax:402-364-2496
Practice Address - Street 1:106 N JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:NE
Practice Address - Zip Code:68335-3010
Practice Address - Country:US
Practice Address - Phone:402-364-2225
Practice Address - Fax:402-364-2477
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE74233163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE74233OtherSTATE OF NEBRASKA