MEDICARE: JANELLE MARIA HANNA PA C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	680	CO
2	363A00000X	Physician Assistant	335815-1206	UT
3	363A00000X	Physician Assistant	680	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437149820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANELLE MARIA HANNA PA C

Provider Business Mailing Address
First Line	:	PO BOX 95460
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44101-0033
Country	:	US
Telephone Number	:	602-581-6076
Fax Number	:	602-263-1619

Provider Business Practice Location Address
First Line	:	20950 N TATUM BLVD STE 190
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4251
Country	:	US
Telephone Number	:	480-360-9814
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	03/26/2026

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