Provider Demographics
NPI:1831207968
Name:BRASUELL, GINGER LYNN (APRN-C)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:LYNN
Last Name:BRASUELL
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:MS
Other - First Name:GINGER
Other - Middle Name:LYNN
Other - Last Name:BRASUELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-C
Mailing Address - Street 1:1013 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-2635
Mailing Address - Country:US
Mailing Address - Phone:308-635-0882
Mailing Address - Fax:308-635-0883
Practice Address - Street 1:1013 E 19TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-2635
Practice Address - Country:US
Practice Address - Phone:308-635-0882
Practice Address - Fax:308-635-0883
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110486363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100264473-00Medicaid
NE100264472-00Medicaid
NE100264472-00Medicaid