Provider Demographics
NPI:1437341120
Name:HANES, BRANDY LYNN (NP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:LYNN
Last Name:HANES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:NE
Mailing Address - Zip Code:69033-3130
Mailing Address - Country:US
Mailing Address - Phone:308-882-7299
Mailing Address - Fax:
Practice Address - Street 1:600 W 12TH ST
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:NE
Practice Address - Zip Code:69033-3130
Practice Address - Country:US
Practice Address - Phone:308-882-7299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR160622-5363L00000X
NE111005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner