Provider Demographics
NPI:1780383364
Name:BLACK, ANDREW (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BLACK
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-1946
Mailing Address - Country:US
Mailing Address - Phone:402-477-9200
Mailing Address - Fax:
Practice Address - Street 1:1411 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1946
Practice Address - Country:US
Practice Address - Phone:402-477-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily