Provider Demographics
NPI:1659331338
Name:HANNA, ELBERT LELAND (LPN)
Entity Type:Individual
Prefix:MR
First Name:ELBERT
Middle Name:LELAND
Last Name:HANNA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-9481
Mailing Address - Country:US
Mailing Address - Phone:440-969-9792
Mailing Address - Fax:
Practice Address - Street 1:7301 DEPOT RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-9481
Practice Address - Country:US
Practice Address - Phone:440-969-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH100090164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2150149Medicaid