Provider Demographics
NPI:1932645629
Name:HANNICK, MARY ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:HANNICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 PLAINVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4254
Mailing Address - Country:US
Mailing Address - Phone:540-533-4602
Mailing Address - Fax:
Practice Address - Street 1:900 BEASLEY ST
Practice Address - Street 2:#120
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-4266
Practice Address - Country:US
Practice Address - Phone:859-254-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator