Provider Demographics
NPI:1992561674
Name:BROEKEMEIER, RANDI NICOLE (RN)
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:NICOLE
Last Name:BROEKEMEIER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:RANDI
Other - Middle Name:NICOLE
Other - Last Name:REIMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6009 K AVENUE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847
Mailing Address - Country:US
Mailing Address - Phone:308-233-1128
Mailing Address - Fax:
Practice Address - Street 1:6009 K AVENUE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847
Practice Address - Country:US
Practice Address - Phone:308-233-1128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE71856163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse