Provider Demographics
NPI:1265189302
Name:HANNEGAN, COURTNEY E (APNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:E
Last Name:HANNEGAN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S PARK ST STE 210
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2168
Mailing Address - Country:US
Mailing Address - Phone:844-493-1052
Mailing Address - Fax:
Practice Address - Street 1:2222 S PARK ST STE 210
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2168
Practice Address - Country:US
Practice Address - Phone:844-493-1052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11509363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner