Provider Demographics
NPI:1346372554
Name:IAN, HANNA (NMD)
Entity Type:Individual
Prefix:DR
First Name:HANNA
Middle Name:
Last Name:IAN
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15436 W. STATLER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:623-792-8889
Mailing Address - Fax:623-792-5097
Practice Address - Street 1:15436 W. STATLER CIRCLE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-792-8889
Practice Address - Fax:623-215-7453
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05-859175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ05-859OtherMEDICAL LICENSE