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NPI Code Detail

MEDICARE: BRADY W HANQUIST P.A.C.

MEDICARE: BRADY W HANQUIST P.A.C.
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
1363A00000XPhysician Assistant1470NE

General Provider Information

NPI Number : 1972838688
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADY W HANQUIST P.A.C.
Provider Business Mailing Address
First Line : 1101 N 10TH ST
Second Line :
City : BEATRICE
State : NE
Zip : 68310-2001
Country : US
Telephone Number : 402-228-3436
Fax Number : 402-223-4515
Provider Business Practice Location Address
First Line : 1101 N 10TH ST
Second Line :
City : BEATRICE
State : NE
Zip : 68310-2001
Country : US
Telephone Number : 402-228-3436
Fax Number : 402-223-4515
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2009
Last Update Date : 09/15/2011

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