Provider Demographics
NPI:1548428204
Name:HANNIGAN, BARBARA (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:HANNIGAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ROCK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-1218
Mailing Address - Country:US
Mailing Address - Phone:914-937-8702
Mailing Address - Fax:
Practice Address - Street 1:20 ROCK RIDGE DR
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-1218
Practice Address - Country:US
Practice Address - Phone:914-937-8702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4272441163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02243965Medicaid