Provider Demographics
NPI:1316206923
Name:PLATTE VALLEY WOMENS HEALTHCARE, PC
Entity Type:Organization
Organization Name:PLATTE VALLEY WOMENS HEALTHCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HASENAUER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:308-534-0090
Mailing Address - Street 1:810 W REID AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6583
Mailing Address - Country:US
Mailing Address - Phone:308-534-0090
Mailing Address - Fax:308-534-0091
Practice Address - Street 1:810 W REID AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6583
Practice Address - Country:US
Practice Address - Phone:308-534-0090
Practice Address - Fax:308-534-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18908207V00000X
NE110460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty