Provider Demographics
NPI:1760159453
Name:HANSEN, JED R (APRN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:JED
Middle Name:R
Last Name:HANSEN
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15280 CUMING ST # NE68154
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1846
Mailing Address - Country:US
Mailing Address - Phone:402-686-0564
Mailing Address - Fax:
Practice Address - Street 1:8141 W CENTER RD STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3273
Practice Address - Country:US
Practice Address - Phone:402-717-3000
Practice Address - Fax:402-717-3030
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113789363LF0000X
NE75867163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse