Provider Demographics
NPI:1093982449
Name:HANNON, CATHERINE FLORENCE (LPN)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:FLORENCE
Last Name:HANNON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1920
Mailing Address - Country:US
Mailing Address - Phone:631-901-3357
Mailing Address - Fax:
Practice Address - Street 1:1571 MEADOWBROOK RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-1920
Practice Address - Country:US
Practice Address - Phone:631-901-3357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207735164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01494031Medicaid