Provider Demographics
NPI:1720885403
Name:HANSEN, STACEY LYNN
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LYNN
Last Name:HANSEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8524 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68112-2224
Mailing Address - Country:US
Mailing Address - Phone:402-451-8379
Mailing Address - Fax:
Practice Address - Street 1:8524 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68112-2224
Practice Address - Country:US
Practice Address - Phone:402-451-8379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist