Provider Demographics
NPI:1962606137
Name:RICHARDSON, BRYNN ELAINA (MD)
Entity type:Individual
Prefix:DR
First Name:BRYNN
Middle Name:ELAINA
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 N 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-5047
Mailing Address - Country:US
Mailing Address - Phone:402-660-1711
Mailing Address - Fax:
Practice Address - Street 1:981225 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-1225
Practice Address - Country:US
Practice Address - Phone:402-559-7777
Practice Address - Fax:402-559-8940
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23526207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology