Provider Demographics
NPI:1376343673
Name:REWERTS, BRADLEY ALAN
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:ALAN
Last Name:REWERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10295 N MARIAN RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-1713
Mailing Address - Country:US
Mailing Address - Phone:402-460-0621
Mailing Address - Fax:
Practice Address - Street 1:10295 N MARIAN RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-1713
Practice Address - Country:US
Practice Address - Phone:402-460-0621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant