Healthcare Provider Details

I. General information

NPI: 1356391296
Provider Name (Legal Business Name): JEFFREY N HAWTHORNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 WAKELEY PLAZA
OMAHA NE
68114-3651
US

IV. Provider business mailing address

7801 WAKELEY PLAZA
OMAHA NE
68114-3651
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-4855
  • Fax: 402-391-6818
Mailing address:
  • Phone: 402-391-4855
  • Fax: 402-391-6818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number18558
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: