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General NPI Number Information
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NPI Number | 1497187678
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Entity Type | Organization
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Legal Business Name | PATRICIA M. HANNAN, CRNA, LLC
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Dates
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Enumeration Date | 07/30/2013
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Last Update Date | 07/30/2013
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Provider Practice Location Address
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Address Line | 110 PEPPER HILL WAY
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City | AIKEN
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State | SC
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Zip | 29801-2818
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Country | US
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Telephone | 703-642-6060
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Fax | 803-642-0754
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Provider Business Mailing Address
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Address Line | ONE TENTH STREET SUITE 400
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City | AUGUSTA
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State | GA
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Zip | 30901-0126
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Country | US
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Telephone | 706-722-9090
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Fax | 706-722-9092
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Authorized Official
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Title or Position | SELF/OWNER
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Name | PATRICIA MACK HANNAN
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Credential | CRNA
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Telephone | 803-293-8080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 571116450
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License Number State | GA
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