Provider Demographics
NPI:1619155892
Name:HANNIGAN, JOAN MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:HANNIGAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 MAIN ST
Mailing Address - Street 2:SUITE 223
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-5839
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2505 MAIN ST
Practice Address - Street 2:SUITE 223
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5839
Practice Address - Country:US
Practice Address - Phone:203-375-5812
Practice Address - Fax:203-375-6027
Is Sole Proprietor?:No
Enumeration Date:2008-02-10
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000722363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics