Healthcare Provider Details

I. General information

NPI: 1467388934
Provider Name (Legal Business Name): MR. MOHAMOUD A HASSAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S CHERRY ST
GRAND ISLAND NE
68801-1911
US

IV. Provider business mailing address

415 S CHERRY ST APT G35
GRAND ISLAND NE
68801-1905
US

V. Phone/Fax

Practice location:
  • Phone: 308-267-3246
  • Fax:
Mailing address:
  • Phone: 308-267-3246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberH14295895
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: