Provider Demographics
NPI:1538322979
Name:HANNA-SLAGLE, COLLEEN MARIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARIE
Last Name:HANNA-SLAGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 S 30TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-1590
Mailing Address - Country:US
Mailing Address - Phone:402-502-8846
Mailing Address - Fax:402-991-5642
Practice Address - Street 1:4920 S 30TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1590
Practice Address - Country:US
Practice Address - Phone:402-502-8846
Practice Address - Fax:402-991-5642
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0078208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics