Healthcare Provider Details

I. General information

NPI: 1598629248
Provider Name (Legal Business Name): QUENTIN JOSEPH HANZLIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6035 WALKER AVE
LINCOLN NE
68507-2465
US

IV. Provider business mailing address

6035 WALKER AVE
LINCOLN NE
68507-2465
US

V. Phone/Fax

Practice location:
  • Phone: 402-699-7881
  • Fax:
Mailing address:
  • Phone: 402-699-7881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberH14187089
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: