Healthcare Provider Details

I. General information

NPI: 1932260254
Provider Name (Legal Business Name): TERRI MARIE HANNAH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 W MARTIN LUTHER KING JR BLVD
LOS ANGELES CA
90037-1205
US

IV. Provider business mailing address

1536 PLYMOUTH LN
SAN PEDRO CA
90732-4055
US

V. Phone/Fax

Practice location:
  • Phone: 323-328-0800
  • Fax: 323-238-0875
Mailing address:
  • Phone: 310-418-9544
  • Fax: 323-750-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP8949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: