Provider Demographics
NPI:1730793787
Name:ANZALONE, HANNAH ALISE (PA-C)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ALISE
Last Name:ANZALONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1469
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:70443-1469
Mailing Address - Country:US
Mailing Address - Phone:985-351-5605
Mailing Address - Fax:
Practice Address - Street 1:648 CRESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8261
Practice Address - Country:US
Practice Address - Phone:985-805-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA323623363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant