Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 111892 | NE |
NPI | 1033586722 |
---|---|
Provider Name | Jenny Hanshaw |
First Address | Beatrice, NE 68310-6906 |
Second Address | Beatrice, NE 68310-6906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2015 |
Last Update Date | 28/08/2015 |