Healthcare Provider Details

I. General information

NPI: 1922064740
Provider Name (Legal Business Name): STAN LEE HINZMANN C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16901 LAKESIDE HILLS CT
OMAHA NE
68130-2318
US

IV. Provider business mailing address

1040 N BELL ST
FREMONT NE
68025-4347
US

V. Phone/Fax

Practice location:
  • Phone: 402-572-6500
  • Fax: 402-572-6501
Mailing address:
  • Phone: 402-727-7990
  • Fax: 402-727-1761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100461
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: