Provider Demographics
NPI:1902894082
Name:BREMER, KELLI (MD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:BREMER
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 1:2001 PINE LAKE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-3631
Mailing Address - Country:US
Mailing Address - Phone:402-447-7221
Mailing Address - Fax:402-447-7222
Practice Address - Street 1:2001 PINE LAKE RD STE 300
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-3631
Practice Address - Country:US
Practice Address - Phone:402-447-7221
Practice Address - Fax:402-447-7222
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE211102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
099570011OtherMEDICARE
NE10025382000Medicaid