Provider Demographics
NPI:1548564347
Name:HANNON, MARY ELIZABETH (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:HANNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 W 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:WI
Mailing Address - Zip Code:53108-9735
Mailing Address - Country:US
Mailing Address - Phone:414-243-3663
Mailing Address - Fax:
Practice Address - Street 1:5819 W 8 MILE RD
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:WI
Practice Address - Zip Code:53108-9735
Practice Address - Country:US
Practice Address - Phone:414-243-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI115333-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse