Provider Demographics
NPI:1396442661
Name:HANNA, LILLIAN P (WELLNESS COACH)
Entity type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:P
Last Name:HANNA
Suffix:
Gender:F
Credentials:WELLNESS COACH
Other - Prefix:
Other - First Name:REV. LILLIAN
Other - Middle Name:P
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CHRISTIAN MINISTER
Mailing Address - Street 1:566 W FULTON STREET EXT
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-6308
Mailing Address - Country:US
Mailing Address - Phone:518-571-2278
Mailing Address - Fax:
Practice Address - Street 1:566 W FULTON STREET EXT # 105
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-6308
Practice Address - Country:US
Practice Address - Phone:518-571-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach