MEDICARE: MRS. ANDREA MARIE HEMENWAY

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1962738302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA MARIE HEMENWAY

Provider Business Mailing Address
First Line	:	105 E NORFOLK AVE
Second Line	:	SUITE #118
City	:	NORFOLK
State	:	NE
Zip	:	68701-5323
Country	:	US
Telephone Number	:	402-370-4204
Fax Number	:	402-370-4206

Provider Business Practice Location Address
First Line	:	105 E NORFOLK AVE
Second Line	:	SUITE 118
City	:	NORFOLK
State	:	NE
Zip	:	68701-5323
Country	:	US
Telephone Number	:	402-370-4204
Fax Number	:	402-370-4206

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

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	01/23/2015

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