Provider Demographics
NPI:1811999501
Name:BREDENKAMP, NANCY D (APRN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:D
Last Name:BREDENKAMP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:D
Other - Last Name:FAGOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:102 N PINE ST
Mailing Address - Street 2:BLUE HILL CLINIC-MLMH
Mailing Address - City:BLUE HILL
Mailing Address - State:NE
Mailing Address - Zip Code:68930-5532
Mailing Address - Country:US
Mailing Address - Phone:402-756-2141
Mailing Address - Fax:402-756-2142
Practice Address - Street 1:102 N PINE ST
Practice Address - Street 2:BLUE HILL CLINIC-MLMH
Practice Address - City:BLUE HILL
Practice Address - State:NE
Practice Address - Zip Code:68930-5532
Practice Address - Country:US
Practice Address - Phone:402-756-2141
Practice Address - Fax:402-756-2142
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01597OtherBLUE CROSS BLUE SHIELD NE
NE01597OtherBLUE CROSS BLUE SHIELD NE
NE277675Medicare ID - Type Unspecified