MEDICARE: HANNAH MANBOAH-ROCKSON AGPCNP-BC

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	363LG0600X	Gerontology Nurse Practitioner	250509	GA

General Provider Information

NPI Number	:	1720765878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH MANBOAH-ROCKSON AGPCNP-BC

Provider Business Mailing Address
First Line	:	1602 LAPLAND DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30045-4411
Country	:	US
Telephone Number	:	678-763-1097
Fax Number	:

Provider Business Practice Location Address
First Line	:	1602 LAPLAND DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30045-4411
Country	:	US
Telephone Number	:	678-763-1097
Fax Number	:

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

Provider Enumeration Date	:	06/30/2023
Last Update Date	:	06/30/2023

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