Healthcare Provider Details

I. General information

NPI: 1700371739
Provider Name (Legal Business Name): PATRICIA OSBORNE HANNON PHD, PMHCNS, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 SHOEMAKER AVE
WEST WYOMING PA
18644-1020
US

IV. Provider business mailing address

220 S IRVING AVE
SCRANTON PA
18505-2045
US

V. Phone/Fax

Practice location:
  • Phone: 570-718-1996
  • Fax:
Mailing address:
  • Phone: 570-677-5909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN197914L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberCNS5000146
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: