Healthcare Provider Details

I. General information

NPI: 1922073618
Provider Name (Legal Business Name): JACKIE M HINZMAN PA- C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2662 CORNHUSKER HWY SUITE 100
LINCOLN NE
68521-1464
US

IV. Provider business mailing address

3901 W SPRINGVIEW RD
LINCOLN NE
68522-8742
US

V. Phone/Fax

Practice location:
  • Phone: 402-423-0396
  • Fax: 402-423-0397
Mailing address:
  • Phone: 402-476-6738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1214
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1214
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: