Provider Demographics
NPI:1285131375
Name:CRONSTROM, BRIAN WILLIAM (APRN-C)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:WILLIAM
Last Name:CRONSTROM
Suffix:
Gender:
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:COZAD
Mailing Address - State:NE
Mailing Address - Zip Code:69130-0108
Mailing Address - Country:US
Mailing Address - Phone:308-784-2261
Mailing Address - Fax:308-784-4691
Practice Address - Street 1:300 E 12TH ST
Practice Address - Street 2:
Practice Address - City:COZAD
Practice Address - State:NE
Practice Address - Zip Code:69130-1532
Practice Address - Country:US
Practice Address - Phone:308-784-2261
Practice Address - Fax:308-784-4961
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112437363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47037660412Medicaid
IA1285131375Medicaid
NE47068731798Medicaid
NE47068731749Medicaid
IA1285131375Medicaid
NE47068731721Medicaid
NE47068731734Medicaid