Provider Demographics
NPI:1376008136
Name:HANNEN, JOSIAH
Entity Type:Individual
Prefix:
First Name:JOSIAH
Middle Name:
Last Name:HANNEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 TOWNSHIP ROAD 138
Mailing Address - Street 2:
Mailing Address - City:DILLONVALE
Mailing Address - State:OH
Mailing Address - Zip Code:43917-7942
Mailing Address - Country:US
Mailing Address - Phone:724-312-5963
Mailing Address - Fax:
Practice Address - Street 1:325 N MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-8005
Practice Address - Country:US
Practice Address - Phone:937-619-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2314363A00000X
OH50.005641RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty