Healthcare Provider Details

I. General information

NPI: 1316563224
Provider Name (Legal Business Name): KELLEY S. HANAU, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 S 86TH ST STE 102
LINCOLN NE
68526-9253
US

IV. Provider business mailing address

9840 SPRINGLAKE SOUTH LN
FIRTH NE
68358-7590
US

V. Phone/Fax

Practice location:
  • Phone: 402-476-7557
  • Fax: 402-476-9912
Mailing address:
  • Phone: 402-560-2160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLEY SUE HANAU
Title or Position: OWNER/APRN
Credential: APRN-NP, FNP-BC, PMH
Phone: 402-560-2160