Provider Demographics
NPI:1104914282
Name:BREY, BETH (APRN)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:BREY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:OTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7440 S 91ST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9797
Mailing Address - Country:US
Mailing Address - Phone:402-489-6555
Mailing Address - Fax:402-328-3770
Practice Address - Street 1:7440 S 91ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9797
Practice Address - Country:US
Practice Address - Phone:402-489-6555
Practice Address - Fax:402-328-3770
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110332363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026072500Medicaid
NE47070592300Medicaid
NE10026072600Medicaid
NE47070592301Medicaid
NE47070592305Medicaid
NE47070592302Medicaid
NE47070592306Medicaid
NE47070592313Medicaid
P04793Medicare UPIN
NE47070592306Medicaid
NE47070592301Medicaid
NE47070592305Medicaid
KSKA2283006Medicare PIN
NENA1079041Medicare PIN
NE271796Medicare PIN
NE500011618Medicare PIN