MEDICARE: MRS. HANNAH ARCHUNDIA BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BACB533820	NE

General Provider Information

NPI Number	:	1730964628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HANNAH ARCHUNDIA BCBA

Provider Business Mailing Address
First Line	:	901 E 14TH ST
Second Line	:
City	:	WAYNE
State	:	NE
Zip	:	68787-1201
Country	:	US
Telephone Number	:	402-375-3011
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 E 14TH ST
Second Line	:
City	:	WAYNE
State	:	NE
Zip	:	68787-1201
Country	:	US
Telephone Number	:	402-375-3011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	08/29/2023

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