1447673363 NPI number — REGINA MARIE HANCOCK APRN, FNP-BC

Table of content: REGINA MARIE HANCOCK APRN, FNP-BC (NPI 1447673363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447673363 NPI number — REGINA MARIE HANCOCK APRN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANCOCK
Provider First Name:
REGINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447673363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16901 LAKESIDE HILLS COURT
Provider Second Line Business Mailing Address:
ATTN: HOSPITAL MEDICINE
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-524-4001
Provider Business Mailing Address Fax Number:
402-717-7340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16901 LAKESIDE HILLS COURT
Provider Second Line Business Practice Location Address:
ATTN: HOSPITAL MEDICINE
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68130-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-717-8434
Provider Business Practice Location Address Fax Number:
402-717-7340
Provider Enumeration Date:
01/29/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  111622 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10025519100 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 098684524 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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