Provider Demographics
NPI:1477892206
Name:HANNER, SUE (FNP)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:HANNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-0587
Mailing Address - Country:US
Mailing Address - Phone:830-672-7581
Mailing Address - Fax:830-672-8481
Practice Address - Street 1:1818 E US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:WAELDER
Practice Address - State:TX
Practice Address - Zip Code:78959-4001
Practice Address - Country:US
Practice Address - Phone:830-778-7280
Practice Address - Fax:830-778-7623
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248926163W00000X
TX124097363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9772572825OtherCME
TXFO713269OtherAANP
TXMH3668677OtherDEA