1245438167 NPI number — MS. MICHELLE K BRESTER APRN

Table of content: MS. MICHELLE K BRESTER APRN (NPI 1245438167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245438167 NPI number — MS. MICHELLE K BRESTER APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRESTER
Provider First Name:
MICHELLE
Provider Middle Name:
K
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALL
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245438167
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CHILDREN'S HOSPITAL
Provider Second Line Business Mailing Address:
8200 DODGE STREET
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68114-4113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-955-5400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CHILDREN'S HOSPITAL - ANESTHESIOLOGY
Provider Second Line Business Practice Location Address:
8200 DODGE STREET
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68114-4113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-955-4303
Provider Business Practice Location Address Fax Number:
402-955-4300
Provider Enumeration Date:
07/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  110547 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10025384000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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