Individual
THERESA JANE HANNIBAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
525 PARK AVE, PRESCOTT, AZ 86303-4055
(928) 583-2839
Mailing address
525 PARK AVE, PRESCOTT, AZ 86303-4055
(928) 583-2839
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
138066
AZ
Other
Enumeration date
12/03/2014
Last updated
12/03/2014
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