Healthcare Provider Details

I. General information

NPI: 1952300451
Provider Name (Legal Business Name): NANCYE D HASIAK APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16909 LAKESIDE HILLS CT LAKESIDE PROF CTR N STE 200
OMAHA NE
68130-2318
US

IV. Provider business mailing address

16909 LAKESIDE HILLS CT LAKESIDE PROF CTR N STE 200
OMAHA NE
68130-2318
US

V. Phone/Fax

Practice location:
  • Phone: 402-571-5323
  • Fax: 402-571-2495
Mailing address:
  • Phone: 402-571-5323
  • Fax: 402-571-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number32331
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number110292
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA101261
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: