Provider Demographics
NPI:1588989974
Name:HANNON, ELICIA (LVN)
Entity type:Individual
Prefix:
First Name:ELICIA
Middle Name:
Last Name:HANNON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12125 TAMBOURINE DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-1242
Mailing Address - Country:US
Mailing Address - Phone:832-893-2615
Mailing Address - Fax:
Practice Address - Street 1:12125 TAMBOURINE DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-1242
Practice Address - Country:US
Practice Address - Phone:832-893-2615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190435164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse