Provider Demographics
NPI:1316344906
Name:VIVIAN NELL HANNON
Entity type:Organization
Organization Name:VIVIAN NELL HANNON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CRNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:NELL
Authorized Official - Last Name:HANNON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-582-6377
Mailing Address - Street 1:5447 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:AL
Mailing Address - Zip Code:35747-6211
Mailing Address - Country:US
Mailing Address - Phone:256-728-2272
Mailing Address - Fax:256-728-2282
Practice Address - Street 1:1241 BLOUNT AVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-1831
Practice Address - Country:US
Practice Address - Phone:256-582-6377
Practice Address - Fax:256-582-6376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty