MEDICARE: DAVID HAHN FNP

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	363LF0000X	Family Nurse Practitioner	338919	NY

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

General Provider Information

NPI Number	:	1841606803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID HAHN FNP

Provider Business Mailing Address
First Line	:	PO BOX 423
Second Line	:
City	:	PENN YAN
State	:	NY
Zip	:	14527-0423
Country	:	US
Telephone Number	:	315-531-9102
Fax Number	:	315-531-9103

Provider Business Practice Location Address
First Line	:	60 MAIN STREET
Second Line	:
City	:	PT BYRON
State	:	NY
Zip	:	13140-0359
Country	:	US
Telephone Number	:	315-776-9700
Fax Number	:	315-776-9701

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

Provider Enumeration Date	:	07/10/2014
Last Update Date	:	05/25/2016

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