Basic Information
| Provider Information | |||||||||
| NPI: | 1154997732 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIERKS | ||||||||
| FirstName: | BRIANNA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 S 16TH ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685023704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024818566 | ||||||||
| FaxNumber: | 4024818805 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 S 48TH ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685061283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024818566 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2021 | ||||||||
| LastUpdateDate: | 07/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2618 | NE | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207Q00000X | 2618 | NE | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 2618 | NE | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.