Provider Demographics
NPI:1407228844
Name:HANNON, EILEEN MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:MARIE
Last Name:HANNON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 IRON WOOD STREET
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751
Mailing Address - Country:US
Mailing Address - Phone:631-277-8779
Mailing Address - Fax:
Practice Address - Street 1:39 IRON WOOD STREET
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751
Practice Address - Country:US
Practice Address - Phone:631-277-8779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302838363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health