Provider Demographics
NPI:1609673144
Name:HAHN, JACKIE MICHELE
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:MICHELE
Last Name:HAHN
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 1:56910 714TH RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBURY
Mailing Address - State:NE
Mailing Address - Zip Code:68352-4040
Mailing Address - Country:US
Mailing Address - Phone:402-587-0768
Mailing Address - Fax:
Practice Address - Street 1:56910 714TH RD
Practice Address - Street 2:
Practice Address - City:FAIRBURY
Practice Address - State:NE
Practice Address - Zip Code:68352-4040
Practice Address - Country:US
Practice Address - Phone:402-587-0768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider