Provider Demographics
NPI:1699880880
Name:HANNA, MARY (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HAMPTON CREEK CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1974
Mailing Address - Country:US
Mailing Address - Phone:803-783-6100
Mailing Address - Fax:
Practice Address - Street 1:425 HAMPTON CREEK CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1974
Practice Address - Country:US
Practice Address - Phone:803-783-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32449163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health