Provider Demographics
NPI:1801977566
Name:HANNEKEN, JAN M (ANP)
Entity type:Individual
Prefix:MS
First Name:JAN
Middle Name:M
Last Name:HANNEKEN
Suffix:
Gender:F
Credentials:ANP
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8056
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-747-1171
Mailing Address - Fax:314-362-3192
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:7TH FL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-1171
Practice Address - Fax:314-362-3192
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2019-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO092661363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid
TX8N3814OtherBCBS
TXP00003534OtherRR MEDICARE
TX157143201Medicaid
TX8A52321Medicare PIN