Provider Demographics
NPI:1720095045
Name:HANNAH, ALYSSA (PA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:HANNAH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-3750
Mailing Address - Fax:814-375-9624
Practice Address - Street 1:5 N 3RD ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15851-0907
Practice Address - Country:US
Practice Address - Phone:814-653-8222
Practice Address - Fax:814-353-9305
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA-051623363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA021164Medicare PIN
PAQ18335Medicare UPIN