Healthcare Provider Details

I. General information

NPI: 1790426633
Provider Name (Legal Business Name): CLARISSA HANNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 N CAPITOL AVE STE 640
INDIANAPOLIS IN
46202-1281
US

IV. Provider business mailing address

1917 E HANNA AVE
INDIANAPOLIS IN
46227-3660
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-8881
  • Fax:
Mailing address:
  • Phone: 760-220-0552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number101099864A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: