Provider Demographics
NPI:1295193860
Name:FANEGA, HANNELI M (APN, CNS)
Entity Type:Individual
Prefix:
First Name:HANNELI
Middle Name:M
Last Name:FANEGA
Suffix:
Gender:F
Credentials:APN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 LAKE ZURICH RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3141
Mailing Address - Country:US
Mailing Address - Phone:847-381-5599
Mailing Address - Fax:847-381-1431
Practice Address - Street 1:405 LAKE ZURICH RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3141
Practice Address - Country:US
Practice Address - Phone:847-381-5599
Practice Address - Fax:847-381-1431
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.013409364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041.435688OtherRN LICENSE