Provider Demographics
NPI:1336315118
Name:HANNIG, LYNN E
Entity Type:Individual
Prefix:MISS
First Name:LYNN
Middle Name:E
Last Name:HANNIG
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 1:182 E 14TH AVE
Mailing Address - Street 2:REAR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-1819
Mailing Address - Country:US
Mailing Address - Phone:216-965-8979
Mailing Address - Fax:614-340-7882
Practice Address - Street 1:182 E 14TH AVE
Practice Address - Street 2:REAR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-1819
Practice Address - Country:US
Practice Address - Phone:216-965-8979
Practice Address - Fax:614-340-7882
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2810499Medicaid