Healthcare Provider Details

I. General information

NPI: 1538322979
Provider Name (Legal Business Name): COLLEEN MARIE HANNA-SLAGLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 S 30TH ST SUITE 103
OMAHA NE
68107-1590
US

IV. Provider business mailing address

4920 S 30TH ST SUITE 103
OMAHA NE
68107-1590
US

V. Phone/Fax

Practice location:
  • Phone: 402-502-8846
  • Fax: 402-991-5642
Mailing address:
  • Phone: 402-502-8846
  • Fax: 402-991-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN0078
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: