Provider Demographics
NPI:1912996398
Name:HANNA-REESE, EDWINA LORRAINE (NP, DNP)
Entity Type:Individual
Prefix:DR
First Name:EDWINA
Middle Name:LORRAINE
Last Name:HANNA-REESE
Suffix:
Gender:F
Credentials:NP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 LANDMARK DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-3852
Mailing Address - Country:US
Mailing Address - Phone:707-554-4704
Mailing Address - Fax:707-552-3288
Practice Address - Street 1:1860 LANDMARK DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-3852
Practice Address - Country:US
Practice Address - Phone:707-554-4704
Practice Address - Fax:707-552-3288
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP11850 RN 272036363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21083ZMedicare ID - Type UnspecifiedCORRESPONDENCE & CLAIMS
CAP34364Medicare UPIN