Provider Demographics
NPI:1134983919
Name:HANNAH, BRENT D (DNP, APRN, CRNA)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:D
Last Name:HANNAH
Suffix:
Gender:M
Credentials:DNP, APRN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16008 SPRAGUE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2828
Mailing Address - Country:US
Mailing Address - Phone:765-749-7735
Mailing Address - Fax:
Practice Address - Street 1:8901 INDIAN HILLS DR STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4032
Practice Address - Country:US
Practice Address - Phone:402-505-4713
Practice Address - Fax:402-505-4738
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE147934367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered