Provider Demographics
NPI:1659064830
Name:HANNAN, ERICA LYN
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LYN
Last Name:HANNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LYN
Other - Last Name:DILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 288
Mailing Address - Street 2:
Mailing Address - City:BERGHOLZ
Mailing Address - State:OH
Mailing Address - Zip Code:43908-0288
Mailing Address - Country:US
Mailing Address - Phone:740-381-8851
Mailing Address - Fax:
Practice Address - Street 1:454 4TH ST
Practice Address - Street 2:
Practice Address - City:BERGHOLZ
Practice Address - State:OH
Practice Address - Zip Code:43908-8010
Practice Address - Country:US
Practice Address - Phone:740-381-8851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator