Provider Demographics
NPI:1053014506
Name:OGLEY, BRENNA
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:OGLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 GLOVER RD STE 4
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-3050
Mailing Address - Country:US
Mailing Address - Phone:308-254-4752
Mailing Address - Fax:
Practice Address - Street 1:610 GLOVER RD STE 4
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-3050
Practice Address - Country:US
Practice Address - Phone:308-254-4752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114678363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily