MEDICARE: JENNY LORAINE HACKWELL APRN

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	363LF0000X	Family Nurse Practitioner	113640	NE

General Provider Information

NPI Number	:	1861067241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY LORAINE HACKWELL APRN

Provider Business Mailing Address
First Line	:	7710 MERCY RD STE 130
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-2349
Country	:	US
Telephone Number	:	402-717-2211
Fax Number	:	402-398-6688

Provider Business Practice Location Address
First Line	:	7710 MERCY RD STE 130
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-2349
Country	:	US
Telephone Number	:	402-717-2211
Fax Number	:	402-398-6688

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

Provider Enumeration Date	:	05/26/2021
Last Update Date	:	01/28/2026

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