Provider Demographics
NPI:1598853715
Name:HAMNER, SPENCER A (PA-C)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:A
Last Name:HAMNER
Suffix:
Gender:M
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 1:3883 NORMAL BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5244
Mailing Address - Country:US
Mailing Address - Phone:402-483-8591
Mailing Address - Fax:402-481-8549
Practice Address - Street 1:2300 S 16TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3704
Practice Address - Country:US
Practice Address - Phone:402-481-5190
Practice Address - Fax:402-481-5377
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1186363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE278756Medicare ID - Type Unspecified
NEQ08628Medicare UPIN