Provider Demographics
NPI:1700371739
Name:HANNON, PATRICIA OSBORNE (PHD, PMHCNS, BC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:OSBORNE
Last Name:HANNON
Suffix:
Gender:F
Credentials:PHD, PMHCNS, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-2045
Mailing Address - Country:US
Mailing Address - Phone:570-677-5909
Mailing Address - Fax:
Practice Address - Street 1:1425 SHOEMAKER AVE
Practice Address - Street 2:
Practice Address - City:WEST WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-1020
Practice Address - Country:US
Practice Address - Phone:570-718-1996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN197914L163W00000X
PACNS5000146364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse