Provider Demographics
NPI:1114636115
Name:HANNA, JUSTINE (RN, BSN, RNC-NIC)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:RN, BSN, RNC-NIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 W SUNSET BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6568
Mailing Address - Country:US
Mailing Address - Phone:847-975-3399
Mailing Address - Fax:
Practice Address - Street 1:1683 E SUNSHINE TRAIL
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6568
Practice Address - Country:US
Practice Address - Phone:847-975-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10288456-3102163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10288456-3102OtherRN