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NPI Code Detail

MEDICARE: LEAH YOLANDA HANNON MD

MEDICARE: LEAH YOLANDA HANNON MD
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1689376667
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH YOLANDA HANNON MD
Provider Business Mailing Address
First Line : 260 HOSPITAL DR STE 103
Second Line :
City : UKIAH
State : CA
Zip : 95482-4568
Country : US
Telephone Number : 707-463-7495
Fax Number :
Provider Business Practice Location Address
First Line : 3041 E FLAMINGO RD STE A
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-7447
Country : US
Telephone Number : 702-436-0835
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2023
Last Update Date : 03/06/2026

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