Provider Demographics
NPI:1346900487
Name:HANNON, NIKKI (PAC)
Entity type:Individual
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First Name:NIKKI
Middle Name:
Last Name:HANNON
Suffix:
Gender:F
Credentials:PAC
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Mailing Address - Street 1:5310 KIETZKE LN STE 104
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2043
Mailing Address - Country:US
Mailing Address - Phone:775-348-8800
Mailing Address - Fax:833-687-1419
Practice Address - Street 1:780 VISTA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-6677
Practice Address - Country:US
Practice Address - Phone:775-348-8800
Practice Address - Fax:833-687-1419
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2024-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVPA2879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant