Provider Demographics
NPI:1386692077
Name:NAGENGAST, SUNNY LYNN (RN, APRN)
Entity type:Individual
Prefix:MRS
First Name:SUNNY
Middle Name:LYNN
Last Name:NAGENGAST
Suffix:
Gender:F
Credentials:RN, APRN
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 357
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68718-0357
Mailing Address - Country:US
Mailing Address - Phone:402-373-4341
Mailing Address - Fax:402-373-4344
Practice Address - Street 1:105 S BROADWAY
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NE
Practice Address - Zip Code:68718-0357
Practice Address - Country:US
Practice Address - Phone:402-373-4341
Practice Address - Fax:402-373-4344
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NES27626Medicare UPIN
NE268107Medicare ID - Type UnspecifiedAPRN