Provider Demographics
NPI:1992990782
Name:HANNAH, SHIRLEY ELAINE (NP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ELAINE
Last Name:HANNAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 995
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-0995
Mailing Address - Country:US
Mailing Address - Phone:302-923-4785
Mailing Address - Fax:530-292-4296
Practice Address - Street 1:590 SEARLS AVE STE A
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-3053
Practice Address - Country:US
Practice Address - Phone:530-292-3478
Practice Address - Fax:530-292-4296
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2024-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA16128363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16128OtherCA NP LICENSE