Healthcare Provider Details

I. General information

NPI: 1902006463
Provider Name (Legal Business Name): GLENN J HANN PNP, NPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9221 ROBERT HART DR
DANSVILLE NY
14437-8931
US

IV. Provider business mailing address

9221 ROBERT HART DR
DANSVILLE NY
14437-8931
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-4316
  • Fax: 585-335-3577
Mailing address:
  • Phone: 585-335-4316
  • Fax: 585-335-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number381925
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401510
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: