Provider Demographics
NPI:1235801218
Name:OMONZOGIE, HANNAH MARIE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:MARIE
Last Name:OMONZOGIE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9440 STRATTON DR APT 4107
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-5337
Mailing Address - Country:US
Mailing Address - Phone:469-748-6266
Mailing Address - Fax:
Practice Address - Street 1:9440 STRATTON DR APT 4107
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5337
Practice Address - Country:US
Practice Address - Phone:469-748-6266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353141164X00000X
CA709346164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000000OtherNONE