MEDICARE: JENNIFER AHN HANNER M.D.

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	2084P0800X	Psychiatry Physician	2010-00287	NC
2	390200000X	Student in an Organized Health Care Education/Training Program	239046	NY
3	2084P0800X	Psychiatry Physician	239046	NY
4	2084P0800X	Psychiatry Physician	0101225476	VA

General Provider Information

NPI Number	:	1790977106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER AHN HANNER M.D.

Provider Business Mailing Address
First Line	:	1020 FIRST COLONIAL RD STE A
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3078
Country	:	US
Telephone Number	:	757-395-1850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 FIRST COLONIAL RD STE A
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3078
Country	:	US
Telephone Number	:	757-395-1850
Fax Number	:

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

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	05/22/2024

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