Provider Demographics
NPI:1285711887
Name:HANNAH, DEBRA A (CNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:HANNAH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 E BROAD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1505
Mailing Address - Country:US
Mailing Address - Phone:614-779-0381
Mailing Address - Fax:855-540-4722
Practice Address - Street 1:131 SAUNDERSVILLE RD
Practice Address - Street 2:SUITE 160
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-8903
Practice Address - Country:US
Practice Address - Phone:615-824-3737
Practice Address - Fax:855-540-4722
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP04889363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2382461Medicaid
OHP85265Medicare UPIN
OH2382461Medicaid