Provider Demographics
NPI:1194832717
Name:HANNA, JILL A (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:HANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:A
Other - Last Name:MARTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1065 BUCKS LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971
Mailing Address - Country:US
Mailing Address - Phone:530-283-2121
Mailing Address - Fax:530-283-7953
Practice Address - Street 1:1065 BUCKS LAKE ROAD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971
Practice Address - Country:US
Practice Address - Phone:530-283-2121
Practice Address - Fax:530-283-7953
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60571207Q00000X
NV9314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G605710Medicaid
CA00G605710Medicaid
00G605710Medicare ID - Type Unspecified