Provider Demographics
NPI:1245241017
Name:HANNEN, MARINA N (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:N
Last Name:HANNEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CAMBRIDGE ST STE G600
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8501
Mailing Address - Country:US
Mailing Address - Phone:913-588-9600
Mailing Address - Fax:
Practice Address - Street 1:4000 CAMBRIDGE ST STE 600
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002002036207RC0000X
KS04-29982207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200265440AMedicaid
KS200265440BMedicaid
MO208993105Medicaid
KS103849OtherBCBS KS OUTREACH CLINICS
MO33949011OtherBCBS KC
MO33949011OtherBCBS KC
KS038D112BMedicare PIN
KSP00154380Medicare PIN
MOP00154363Medicare PIN
MO038D112EMedicare PIN
MO038D112AMedicare PIN
KS200265440BMedicaid