Provider Demographics
NPI:1306990809
Name:HANNA, BERNADINE A (MD,)
Entity type:Individual
Prefix:
First Name:BERNADINE
Middle Name:A
Last Name:HANNA
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7220 S CIMARRON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2157
Mailing Address - Country:US
Mailing Address - Phone:702-384-1160
Mailing Address - Fax:702-258-1293
Practice Address - Street 1:7220 S CIMARRON RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113
Practice Address - Country:US
Practice Address - Phone:702-384-1160
Practice Address - Fax:702-835-0676
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2019-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV9626208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018685Medicaid
NV002018685Medicaid
NV002018685Medicaid
NVV37980Medicare PIN