Healthcare Provider Details

I. General information

NPI: 1407816275
Provider Name (Legal Business Name): JOANN HANNIG R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N 8TH ST
SPRINGFIELD IL
62702-6324
US

IV. Provider business mailing address

710 N 8TH ST
SPRINGFIELD IL
62702-6324
US

V. Phone/Fax

Practice location:
  • Phone: 217-525-1064
  • Fax: 217-525-1651
Mailing address:
  • Phone: 217-525-1064
  • Fax: 217-525-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: