Provider Demographics
NPI:1942731047
Name:HANNAH, BENITA
Entity Type:Individual
Prefix:
First Name:BENITA
Middle Name:
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 1:511 SAN JUAN CIR
Mailing Address - Street 2:1
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4852
Mailing Address - Country:US
Mailing Address - Phone:907-306-1660
Mailing Address - Fax:
Practice Address - Street 1:4045 LAKE OTIS PKWY
Practice Address - Street 2:204
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5227
Practice Address - Country:US
Practice Address - Phone:907-276-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK106264225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist