Provider Demographics
NPI:1679648455
Name:HANNON, PATRICIA (PA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:HANNON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:28312 LEWES GEORGETOWN HIGHWAY
Mailing Address - Street 2:COOL SPRING OFFICE PARK
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968
Mailing Address - Country:US
Mailing Address - Phone:302-684-0990
Mailing Address - Fax:302-684-0991
Practice Address - Street 1:28312 LEWES GEORGETOWN HIGHWAY
Practice Address - Street 2:COOL SPRING OFFICE PARK
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968
Practice Address - Country:US
Practice Address - Phone:302-684-0990
Practice Address - Fax:302-684-0991
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000453363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant