Provider Demographics
NPI:1679504583
Name:HANEY, ANN KATHLEEN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:KATHLEEN
Last Name:HANEY
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 1:2100 WINONA DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-2458
Mailing Address - Country:US
Mailing Address - Phone:513-267-1895
Mailing Address - Fax:
Practice Address - Street 1:2100 WINONA DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-2458
Practice Address - Country:US
Practice Address - Phone:513-267-1895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN075029164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2147644Medicaid