Provider Demographics
NPI:1437341120
Name:WALLIN, BRANDY LYNN (NP)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:LYNN
Last Name:WALLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:LYNN
Other - Last Name:HANES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1313 N CHEYENNE ST
Mailing Address - Street 2:
Mailing Address - City:BENKELMAN
Mailing Address - State:NE
Mailing Address - Zip Code:69021-3074
Mailing Address - Country:US
Mailing Address - Phone:308-423-2204
Mailing Address - Fax:
Practice Address - Street 1:1313 N CHEYENNE ST
Practice Address - Street 2:
Practice Address - City:BENKELMAN
Practice Address - State:NE
Practice Address - Zip Code:69021-3074
Practice Address - Country:US
Practice Address - Phone:308-423-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR160622-5363L00000X
NE111005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner