1578801635 NPI number — HANNAH AVERS

Table of content: (NPI 1578801635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578801635 NPI number — HANNAH AVERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANNAH AVERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578801635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
326 PRIMROSE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17554-1230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 BUTLER AVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17601-6311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-207-9857
Provider Business Practice Location Address Fax Number:
717-459-7977
Provider Enumeration Date:
01/24/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AVERS
Authorized Official First Name:
HANNAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
717-207-9857

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  CW017302 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)