Organization
WAHOO MEDICAL P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY ELIZABETH HANNAN PA-C (PRESIDENT)
(402) 443-4600
Entity
Organization
Contact information
Practice address
567 W 15TH ST, WAHOO, NE 68066-1280
(402) 443-4600
(402) 443-4660
Mailing address
567 W 15TH ST, PO BOX 206, WAHOO, NE 68066-1280
(402) 443-4600
(402) 443-4660
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336347616
NPI #
—
Enumeration date
12/16/2009
Last updated
12/16/2009
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