Provider Demographics
NPI:1780776393
Name:HANEY, SUZANNE B (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:B
Last Name:HANEY
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 1:11949 Q ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3503
Mailing Address - Country:US
Mailing Address - Phone:402-595-1326
Mailing Address - Fax:402-595-1329
Practice Address - Street 1:11949 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3503
Practice Address - Country:US
Practice Address - Phone:402-595-1326
Practice Address - Fax:402-595-1329
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24450208000000X, 208000000X
IA37592208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics