Provider Demographics
NPI:1154376267
Name:HORTON-BROWN, NICHELLE R (MD)
Entity type:Individual
Prefix:DR
First Name:NICHELLE
Middle Name:R
Last Name:HORTON-BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NICHELLE
Other - Middle Name:R
Other - Last Name:HORTON-BRWON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3015 N 90TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-4713
Mailing Address - Country:US
Mailing Address - Phone:402-453-6869
Mailing Address - Fax:402-453-6869
Practice Address - Street 1:3015 N 90TH ST STE 1
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-4713
Practice Address - Country:US
Practice Address - Phone:402-453-6869
Practice Address - Fax:402-961-1055
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22626207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEH92693Medicare UPIN
NE276892Medicare ID - Type Unspecified