Healthcare Provider Details

I. General information

NPI: 1164072674
Provider Name (Legal Business Name): HANNAH HANLON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HANNAH KOONS PA-C

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 W MAIN ST
BATAVIA NY
14020-1347
US

IV. Provider business mailing address

20 MAIN ST
ANDOVER NY
14806-9303
US

V. Phone/Fax

Practice location:
  • Phone: 585-599-6446
  • Fax: 585-599-3166
Mailing address:
  • Phone: 607-478-8421
  • Fax: 607-478-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number024039
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: