Provider Demographics
NPI:1669038055
Name:HANNA, CATHY JEANNE (LPN)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:JEANNE
Last Name:HANNA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 VINE CIR
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-2320
Mailing Address - Country:US
Mailing Address - Phone:315-736-5040
Mailing Address - Fax:
Practice Address - Street 1:15 VINE CIR
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492-2320
Practice Address - Country:US
Practice Address - Phone:315-736-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-12
Last Update Date:2019-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097761164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse