Healthcare Provider Details

I. General information

NPI: 1164653002
Provider Name (Legal Business Name): MOLLY LAUREN HANNASCH P.A.- C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S 70TH ST SUITE 202
LINCOLN NE
68506-1576
US

IV. Provider business mailing address

PO BOX 6971
LINCOLN NE
68506-0971
US

V. Phone/Fax

Practice location:
  • Phone: 402-328-8833
  • Fax: 402-328-2921
Mailing address:
  • Phone: 402-486-7083
  • Fax: 402-434-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1457
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: