Provider Demographics
NPI:1740781566
Name:EDGE, HANNA LYNN
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:LYNN
Last Name:EDGE
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 1:6094 ZANE TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9761
Mailing Address - Country:US
Mailing Address - Phone:937-382-6661
Mailing Address - Fax:
Practice Address - Street 1:720 ELM ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2878
Practice Address - Country:US
Practice Address - Phone:937-382-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program