Provider Demographics
NPI:1497797260
Name:HANNANEY, MARYANNE A (MD)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:A
Last Name:HANNANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 GASSER RD.
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501
Mailing Address - Country:US
Mailing Address - Phone:307-856-4232
Mailing Address - Fax:307-856-4243
Practice Address - Street 1:2300 GASSER RD.
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501
Practice Address - Country:US
Practice Address - Phone:307-856-4232
Practice Address - Fax:307-856-4243
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6798A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY118601900Medicaid
WYA76817Medicare UPIN
WY9818Medicare ID - Type Unspecified