Provider Demographics
NPI:1437793049
Name:HANAK, HOLLY JUNE (PNP)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:JUNE
Last Name:HANAK
Suffix:
Gender:F
Credentials:PNP
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-6120
Mailing Address - Fax:314-454-4225
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DEPT NEUROLOGY, STE 2130
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6120
Practice Address - Fax:314-454-4225
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2024-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2019024912363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420092475Medicaid