Provider Demographics
NPI:1477857985
Name:SIMON, HANNAH LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:LYNN
Last Name:SIMON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:HANNAH
Other - Middle Name:LYNN
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2315 MYRTLE ST STE 290
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-4609
Mailing Address - Country:US
Mailing Address - Phone:814-452-7300
Mailing Address - Fax:814-452-5015
Practice Address - Street 1:2315 MYRTLE ST STE 290
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4602
Practice Address - Country:US
Practice Address - Phone:814-452-7300
Practice Address - Fax:814-452-5015
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054588363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
12184218OtherCAQH
PA103201598Medicaid