Healthcare Provider Details

I. General information

NPI: 1699880880
Provider Name (Legal Business Name): MARY HANNA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 HAMPTON CREEK CT
COLUMBIA SC
29209-1974
US

IV. Provider business mailing address

425 HAMPTON CREEK CT
COLUMBIA SC
29209-1974
US

V. Phone/Fax

Practice location:
  • Phone: 803-783-6100
  • Fax:
Mailing address:
  • Phone: 803-783-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number32449
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: