Provider Demographics
NPI:1710574363
Name:HANNAH, TARA CATRICE
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:CATRICE
Last Name:HANNAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S BELVOIR BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2947
Mailing Address - Country:US
Mailing Address - Phone:216-355-4146
Mailing Address - Fax:
Practice Address - Street 1:24320 GESSNER RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-1548
Practice Address - Country:US
Practice Address - Phone:440-777-2878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker