Healthcare Provider Details

I. General information

NPI: 1215258421
Provider Name (Legal Business Name): DR KATHRYN HAJJ MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4535 NORMAL BLVD STE 105
LINCOLN NE
68506-2891
US

IV. Provider business mailing address

4535 NORMAL BLVD STE 105
LINCOLN NE
68506-2891
US

V. Phone/Fax

Practice location:
  • Phone: 402-488-4861
  • Fax: 402-488-4864
Mailing address:
  • Phone: 402-488-4861
  • Fax: 402-488-4864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number20252
License Number StateNE

VIII. Authorized Official

Name: DR. KATHRYN HAJJ
Title or Position: DOCTOR
Credential: MD
Phone: 402-488-4861