Individual
JILL M. HAGENKORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
601 N 30TH ST, OMAHA, NE 68131-2137
(402) 449-4630
Mailing address
PO BOX 2159, OMAHA, NE 68103-2159
(402) 449-4630
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
24682
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47037658308
—
NE
Enumeration date
06/16/2008
Last updated
06/16/2008
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