Basic Information
| Provider Information | |||||||||
| NPI: | 1316221385 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRYANLGH WEST MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2046 HEREL ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685123682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024814167 | ||||||||
| FaxNumber: | 4024815100 | ||||||||
| Practice Location | |||||||||
| Address1: | 2046 HEREL ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685123682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024814167 | ||||||||
| FaxNumber: | 4024815100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2011 | ||||||||
| LastUpdateDate: | 10/07/2011 | ||||||||
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| AuthorizedOfficialLastName: | OVERHALSER | ||||||||
| AuthorizedOfficialFirstName: | MICHELE | ||||||||
| AuthorizedOfficialMiddleName: | JOAN | ||||||||
| AuthorizedOfficialTitleorPosition: | NP | ||||||||
| AuthorizedOfficialTelephone: | 4024814167 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | APRN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 111296 | NE | Y | Hospitals | General Acute Care Hospital |
No ID Information.