MEDICARE: CECILY HANNA NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	800854	TX
2	363LF0000X	Family Nurse Practitioner	AP144082	TX

General Provider Information

NPI Number	:	1578104261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILY HANNA NP-C

Provider Business Mailing Address
First Line	:	1014 DAKOTA PASS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251
Country	:	US
Telephone Number	:	830-556-1950
Fax Number	:

Provider Business Practice Location Address
First Line	:	8235 S NEW BRAUNFELS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78235-4439
Country	:	US
Telephone Number	:	210-616-1317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2019
Last Update Date	:	12/11/2019

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