Provider Demographics
NPI:1720863657
Name:HANNAH, CATHLEEN (NP)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:
Last Name:HANNAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12601 FINGERBOARD RD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:MD
Mailing Address - Zip Code:21770-8718
Mailing Address - Country:US
Mailing Address - Phone:607-280-3566
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DR BLDG 10
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0004
Practice Address - Country:US
Practice Address - Phone:607-280-3566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily