Healthcare Provider Details

I. General information

NPI: 1649954439
Provider Name (Legal Business Name): HANNAH CATHERINE YACKLEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114-4113
US

IV. Provider business mailing address

8200 DODGE ST
OMAHA NE
68114-4113
US

V. Phone/Fax

Practice location:
  • Phone: 820-068-1144
  • Fax:
Mailing address:
  • Phone: 820-068-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number3139
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR-12896
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: