Provider Demographics
NPI:1356512883
Name:VIVIAN N HANNON
Entity type:Organization
Organization Name:VIVIAN N HANNON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:HANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-498-5770
Mailing Address - Street 1:1241 BLOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-1831
Mailing Address - Country:US
Mailing Address - Phone:256-582-6377
Mailing Address - Fax:
Practice Address - Street 1:4258 HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:LACEYS SPRING
Practice Address - State:AL
Practice Address - Zip Code:35754-6448
Practice Address - Country:US
Practice Address - Phone:256-498-5770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-057030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty