Individual
BRIANNA R THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
717 N 190TH PLZ STE 3200, ELKHORN, NE 68022-3913
(402) 815-1980
(402) 815-1961
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-2100
(402) 354-2155
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2332
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026293200
—
NE
05
—
10026480100
—
NE
05
—
1235695198
—
IA
05
—
47068731734
—
NE
05
—
47068731741
—
NE
05
—
47068731749
—
NE
Enumeration date
02/15/2019
Last updated
03/26/2019
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