Healthcare Provider Details

I. General information

NPI: 1497645634
Provider Name (Legal Business Name): SUSAN JANE HANNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 RUBY AVE
GRAND ISLAND NE
68803-3744
US

IV. Provider business mailing address

1133 RUBY AVE
GRAND ISLAND NE
68803-3744
US

V. Phone/Fax

Practice location:
  • Phone: 308-850-2424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: