Provider Demographics
NPI:1164653002
Name:HANNASCH, MOLLY LAUREN (PA- C)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:LAUREN
Last Name:HANNASCH
Suffix:
Gender:F
Credentials:PA- C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6971
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0971
Mailing Address - Country:US
Mailing Address - Phone:402-486-7083
Mailing Address - Fax:402-434-6047
Practice Address - Street 1:1550 S 70TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1576
Practice Address - Country:US
Practice Address - Phone:402-328-8833
Practice Address - Fax:402-328-2921
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
NE1457363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEN/AOtherMIDLANDS CHOICE
NE24384OtherBCBS
NEN/AOtherHUMANA
NEN/AOtherCOVENTRY
NEN/AOtherHUMANA