Provider Demographics
NPI:1043465206
Name:HANNAH, KAREN MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:HANNAH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 N 19TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-3211
Mailing Address - Country:US
Mailing Address - Phone:602-296-5540
Mailing Address - Fax:602-296-5442
Practice Address - Street 1:5060 N 19TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3211
Practice Address - Country:US
Practice Address - Phone:602-296-5540
Practice Address - Fax:602-296-5442
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
AZAP3208208000000X, 208VP0000X, 405300000X
AZTAP3208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ490223Medicaid