Provider Demographics
NPI:1588279095
Name:HANNA, TAMMY JEAN
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEAN
Last Name:HANNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 11TH ST
Mailing Address - Street 2:
Mailing Address - City:RAINELLE
Mailing Address - State:WV
Mailing Address - Zip Code:25962-1270
Mailing Address - Country:US
Mailing Address - Phone:304-667-5404
Mailing Address - Fax:
Practice Address - Street 1:156 11TH ST
Practice Address - Street 2:
Practice Address - City:RAINELLE
Practice Address - State:WV
Practice Address - Zip Code:25962-1270
Practice Address - Country:US
Practice Address - Phone:304-667-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant