Provider Demographics
NPI:1922059757
Name:HANNAN, MARY F (NP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:F
Last Name:HANNAN
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Gender:F
Credentials:NP
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Mailing Address - Street 1:1333 BURR RIDGE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6423
Mailing Address - Country:US
Mailing Address - Phone:630-832-1775
Mailing Address - Fax:630-832-3078
Practice Address - Street 1:1333 BURR RIDGE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-6423
Practice Address - Country:US
Practice Address - Phone:630-832-1775
Practice Address - Fax:630-832-3078
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2016-11-21
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Provider Licenses
StateLicense IDTaxonomies
WI2650363L00000X
IL209009527363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41264000Medicaid
Q52043Medicare UPIN
WIZ52043Medicare UPIN
WIZ52043Medicare UPIN