Provider Demographics
NPI:1578219622
Name:HANRAHAN, LISANNE FLOTO
Entity Type:Individual
Prefix:
First Name:LISANNE
Middle Name:FLOTO
Last Name:HANRAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 AVONDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2639
Mailing Address - Country:US
Mailing Address - Phone:609-330-3574
Mailing Address - Fax:
Practice Address - Street 1:1000 WHITE HORSE RD STE 806
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4414
Practice Address - Country:US
Practice Address - Phone:609-330-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist