Provider Demographics
NPI:1740363894
Name:HANNAN, TERRI ANN (PA-C)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:ANN
Last Name:HANNAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:ANN
Other - Last Name:VAN METRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2211 SW VINTAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7192
Mailing Address - Country:US
Mailing Address - Phone:585-233-9996
Mailing Address - Fax:
Practice Address - Street 1:2211 SW VINTAGE PKWY
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-7192
Practice Address - Country:US
Practice Address - Phone:585-233-9996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001706363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA04961007Medicare PIN
IAS07237Medicare UPIN