Healthcare Provider Details

I. General information

NPI: 1396984415
Provider Name (Legal Business Name): SHELLY A HAJNY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 O ST
LINCOLN NE
68510-1951
US

IV. Provider business mailing address

7261 MERCY RD
OMAHA NE
68124-2311
US

V. Phone/Fax

Practice location:
  • Phone: 800-253-4368
  • Fax:
Mailing address:
  • Phone: 402-398-6254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1345
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: