Provider Demographics
NPI:1568763043
Name:HANNA, LISA MARGARET (NP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARGARET
Last Name:HANNA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 IMPERIAL HWY
Mailing Address - Street 2:SUITE 730
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1041
Mailing Address - Country:US
Mailing Address - Phone:714-449-4800
Mailing Address - Fax:714-449-4956
Practice Address - Street 1:251 IMPERIAL HWY
Practice Address - Street 2:SUITE 460
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1057
Practice Address - Country:US
Practice Address - Phone:714-578-8503
Practice Address - Fax:714-578-8655
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA575976363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health