Healthcare Provider Details

I. General information

NPI: 1154389930
Provider Name (Legal Business Name): LYNN D O'HANLON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST CHILDRENS HOSPITAL
OMAHA NE
68114-4113
US

IV. Provider business mailing address

8200 DODGE ST CHILDRENS HOSPITAL
OMAHA NE
68114-4113
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-6143
  • Fax:
Mailing address:
  • Phone: 402-955-6143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number2000163030
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number04-28467
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number24893
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: