Provider Demographics
NPI:1740842640
Name:BRANDENBURG, KIMBERLY RAE (APRN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RAE
Last Name:BRANDENBURG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2669
Mailing Address - Country:US
Mailing Address - Phone:402-379-2322
Mailing Address - Fax:
Practice Address - Street 1:1916 15TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-5127
Practice Address - Country:US
Practice Address - Phone:402-910-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily