Provider Demographics
NPI:1265593891
Name:HANAWI, JOHANNA J (NP)
Entity type:Individual
Prefix:MS
First Name:JOHANNA
Middle Name:J
Last Name:HANAWI
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:17360 BROOKHURST ST
Mailing Address - Street 2:ATTN: NETWORK MANAGEMENT
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3720
Mailing Address - Country:US
Mailing Address - Phone:657-241-3592
Mailing Address - Fax:714-665-4614
Practice Address - Street 1:11420 WARNER AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2529
Practice Address - Country:US
Practice Address - Phone:714-549-1300
Practice Address - Fax:949-798-4406
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2019-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA607476363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEQ614ZMedicare PIN
CAWNP16546AMedicare PIN