Provider Demographics
NPI:1457919680
Name:SCOVILLE, HANNAH (DO)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:
Last Name:SCOVILLE
Suffix:
Gender:
Credentials:DO
Other - Prefix:MS
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:SMOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:9211 E 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2900
Mailing Address - Country:US
Mailing Address - Phone:316-274-4501
Mailing Address - Fax:316-274-4473
Practice Address - Street 1:9211 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2900
Practice Address - Country:US
Practice Address - Phone:316-274-4501
Practice Address - Fax:316-274-4473
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-46814207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine