Provider Demographics
NPI:1932260254
Name:HANNAH, TERRI MARIE (NP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:MARIE
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 1:1536 PLYMOUTH LN
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4055
Mailing Address - Country:US
Mailing Address - Phone:310-418-9544
Mailing Address - Fax:323-750-0330
Practice Address - Street 1:874 W MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-1205
Practice Address - Country:US
Practice Address - Phone:323-328-0800
Practice Address - Fax:323-238-0875
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP8949363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner