Provider Demographics
NPI:1902006463
Name:HANN, GLENN J (PNP, NPP)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:J
Last Name:HANN
Suffix:
Gender:M
Credentials:PNP, NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9221 ROBERT HART DR
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-8931
Mailing Address - Country:US
Mailing Address - Phone:585-335-4316
Mailing Address - Fax:585-335-3577
Practice Address - Street 1:9221 ROBERT HART DR
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-8931
Practice Address - Country:US
Practice Address - Phone:585-335-4316
Practice Address - Fax:585-335-3577
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381925363LP0200X
NY401510363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics