Provider Demographics
NPI:1477651693
Name:BEHRENS, BRENT JOHN (PA-C)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:JOHN
Last Name:BEHRENS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-9371
Mailing Address - Country:US
Mailing Address - Phone:402-423-1111
Mailing Address - Fax:402-423-0365
Practice Address - Street 1:8040 S 13TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-9371
Practice Address - Country:US
Practice Address - Phone:402-423-1111
Practice Address - Fax:402-423-0365
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1037207NP0225X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
281938OtherMEDICARE ID
281938OtherMEDICARE ID