Provider Demographics
NPI:1861067241
Name:HACKWELL, JENNY LORAINE (APRN)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LORAINE
Last Name:HACKWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:BOSSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4400 EMILE STREET UNIVERSITY TOWER 3250A
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-2147
Mailing Address - Country:US
Mailing Address - Phone:402-552-3932
Mailing Address - Fax:402-585-0033
Practice Address - Street 1:4400 EMILE STREET UNIVERSITY TOWER 3250A
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-2147
Practice Address - Country:US
Practice Address - Phone:402-552-3932
Practice Address - Fax:402-585-0033
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113640363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily