Provider Demographics
NPI:1316995343
Name:HAAN, JENNI M (PA-C)
Entity type:Individual
Prefix:MS
First Name:JENNI
Middle Name:M
Last Name:HAAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNI
Other - Middle Name:M
Other - Last Name:LEOHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:933 E PIERCE ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4626
Practice Address - Country:US
Practice Address - Phone:712-396-4360
Practice Address - Fax:712-396-7069
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1220363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100263273-00Medicaid
IA1316995343Medicaid
NE470687317-16Medicaid
IAL072100OtherARNP LICENSE
NE1069821OtherNCCPA #
NE1069821OtherNCCPA #
IA058970040Medicare PIN