Healthcare Provider Details

I. General information

NPI: 1760748503
Provider Name (Legal Business Name): MARIE JORDAN HANNA BSN, MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 ALIANT PKWY
ALEXANDER CITY AL
35010-3466
US

IV. Provider business mailing address

PO BOX 2008
ALEXANDER CITY AL
35011-2008
US

V. Phone/Fax

Practice location:
  • Phone: 256-234-4443
  • Fax: 256-234-3686
Mailing address:
  • Phone: 256-234-4443
  • Fax: 256-234-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-111571
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: