Healthcare Provider Details

I. General information

NPI: 1760345037
Provider Name (Legal Business Name): EMILY DENISE HANNAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 SAINT PATRICK CIR
CROSS LANES WV
25313-3501
US

IV. Provider business mailing address

5055 SAINT PATRICK CIR
CROSS LANES WV
25313-3501
US

V. Phone/Fax

Practice location:
  • Phone: 304-202-3864
  • Fax:
Mailing address:
  • Phone: 304-202-3864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number50996904
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: