Provider Demographics
NPI:1093743346
Name:HANNON, BRIDGET L (CRNA)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:L
Last Name:HANNON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:L
Other - Last Name:HESER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2900 S 70TH STREET
Mailing Address - Street 2:SUITE # 450
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-3796
Mailing Address - Country:US
Mailing Address - Phone:402-489-4186
Mailing Address - Fax:402-489-5279
Practice Address - Street 1:2900 S 70TH ST STE 250
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-3693
Practice Address - Country:US
Practice Address - Phone:402-489-4186
Practice Address - Fax:402-489-5279
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101374367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74472275Medicaid
KY74472275Medicaid