Provider Demographics
NPI:1578537676
Name:HANNA, KIMBERLY J (CNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:HANNA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8425 EORDOGH RD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9774
Mailing Address - Country:US
Mailing Address - Phone:419-351-6471
Mailing Address - Fax:
Practice Address - Street 1:8425 EORDOGH RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9774
Practice Address - Country:US
Practice Address - Phone:419-351-6471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-06621363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2338778Medicaid
OH2338778Medicaid
NP10832Medicare ID - Type Unspecified