Healthcare Provider Details

I. General information

NPI: 1487696183
Provider Name (Legal Business Name): SHADIA HANNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RURAL ROUTE 3 BOX 89
LARNED KS
67550-9365
US

IV. Provider business mailing address

RURAL ROUTE 3 BOX 89
LARNED KS
67550-9365
US

V. Phone/Fax

Practice location:
  • Phone: 620-285-4580
  • Fax: 620-285-4579
Mailing address:
  • Phone: 620-285-4580
  • Fax: 620-285-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0800270
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: