Provider Demographics
NPI:1366505760
Name:BOSCHULT, BRANDY SUE (NS)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:SUE
Last Name:BOSCHULT
Suffix:
Gender:F
Credentials:NS
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:SUE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:600 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701
Mailing Address - Country:US
Mailing Address - Phone:402-370-3140
Mailing Address - Fax:402-370-3373
Practice Address - Street 1:600 S 13TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701
Practice Address - Country:US
Practice Address - Phone:402-370-3140
Practice Address - Fax:402-370-3373
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator