Healthcare Provider Details

I. General information

NPI: 1891165510
Provider Name (Legal Business Name): HANNAH L MOONEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH CROSS

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 FIELDS SOUTH DR
CHAMPAIGN IL
61822-3743
US

IV. Provider business mailing address

611 W PARK ST
URBANA IL
61801-2501
US

V. Phone/Fax

Practice location:
  • Phone: 217-902-7527
  • Fax: 217-902-7755
Mailing address:
  • Phone: 217-383-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085005623
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: