Healthcare Provider Details

I. General information

NPI: 1568802874
Provider Name (Legal Business Name): HANA MARIE PAPPAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANA MARIE PANTUSO

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 23RD AVE
ASTORIA NY
11105-1901
US

IV. Provider business mailing address

3711 23RD AVE
ASTORIA NY
11105-1901
US

V. Phone/Fax

Practice location:
  • Phone: 718-721-6166
  • Fax:
Mailing address:
  • Phone: 718-721-6166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number382438
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number643998
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number26NR15509000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: