Basic Information
| Provider Information | |||||||||
| NPI: | 1609368463 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANCASTER | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | HESTON | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6200 GET A WAY TRL | ||||||||
| Address2: | |||||||||
| City: | CROFTON | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687303055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056609996 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 N 29TH ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687014466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4028448284 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2018 | ||||||||
| LastUpdateDate: | 06/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 112471 | NE | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LF0000X | 112471 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.