Healthcare Provider Details

I. General information

NPI: 1881075505
Provider Name (Legal Business Name): MAREESA LAUREN HASENAUER APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E 6TH ST
CURTIS NE
69025-6102
US

IV. Provider business mailing address

39241 S HANSEN RD
WELLFLEET NE
69170-7095
US

V. Phone/Fax

Practice location:
  • Phone: 308-367-4162
  • Fax: 308-367-4164
Mailing address:
  • Phone: 308-530-2053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111822
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: