Provider Demographics
NPI:1528296209
Name:MORAN-HANSEN, JESSICA R (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:MORAN-HANSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 S 144TH ST STE 250
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5236
Mailing Address - Country:US
Mailing Address - Phone:402-778-5250
Mailing Address - Fax:
Practice Address - Street 1:2727 S 144TH ST STE 250
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5236
Practice Address - Country:US
Practice Address - Phone:402-778-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27651207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA2595006Medicare UPIN