Provider Demographics
NPI:1801636816
Name:BANAAG-FABELLA, HANNA DUA (RN)
Entity type:Individual
Prefix:MRS
First Name:HANNA
Middle Name:DUA
Last Name:BANAAG-FABELLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4329
Mailing Address - Country:US
Mailing Address - Phone:360-659-3926
Mailing Address - Fax:360-659-1626
Practice Address - Street 1:1821 GROVE ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4329
Practice Address - Country:US
Practice Address - Phone:360-659-3926
Practice Address - Fax:360-659-1626
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN.61481674163WG0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice