Provider Demographics
NPI:1578363149
Name:BROCK, NICOLE RAE (CNA,)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RAE
Last Name:BROCK
Suffix:
Gender:
Credentials:CNA,
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RAE
Other - Last Name:WEHLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2416 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68524-1538
Mailing Address - Country:US
Mailing Address - Phone:402-480-3031
Mailing Address - Fax:
Practice Address - Street 1:390 N COTNER BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2371
Practice Address - Country:US
Practice Address - Phone:402-287-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide