MEDICARE: MYRNA HANNA

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1558058214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRNA HANNA

Provider Business Mailing Address
First Line	:	5645 MAIN ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-5045
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 COUNTRY VILLAGE LN
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-1007
Country	:	US
Telephone Number	:	347-601-9853
Fax Number	:

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

Provider Enumeration Date	:	04/21/2023
Last Update Date	:	05/01/2023

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Directions to “ MYRNA HANNA ” Practice Location

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