Provider Demographics
NPI:1881284966
Name:BRUENING, SHELBY E (PA)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:E
Last Name:BRUENING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7121 STEPHANIE LN STE 102
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5352
Mailing Address - Country:US
Mailing Address - Phone:970-663-2742
Mailing Address - Fax:970-667-0847
Practice Address - Street 1:7121 STEPHANIE LN STE 102
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5352
Practice Address - Country:US
Practice Address - Phone:402-413-5010
Practice Address - Fax:402-413-5009
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE2576363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty