Provider Demographics
NPI:1427078567
Name:HANNAGAN, MICHELE (FNP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:HANNAGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-3634
Mailing Address - Country:US
Mailing Address - Phone:585-672-1765
Mailing Address - Fax:585-295-6009
Practice Address - Street 1:480 GENESEE ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3634
Practice Address - Country:US
Practice Address - Phone:585-672-1765
Practice Address - Fax:585-295-6009
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334085363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY334085Medicaid