Provider Demographics
NPI:1437149820
Name:HANNA, JANELLE MARIA (PA C)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:MARIA
Last Name:HANNA
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 3RD ST SE
Mailing Address - Street 2:201
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-2063
Mailing Address - Country:US
Mailing Address - Phone:605-554-0858
Mailing Address - Fax:
Practice Address - Street 1:33 3RD ST SE
Practice Address - Street 2:201
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2063
Practice Address - Country:US
Practice Address - Phone:605-554-0858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO680363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60337265Medicaid
NMB3906Medicaid
AZ621020Medicaid
CO60337265Medicaid
S54877Medicare UPIN
NMB3906Medicaid