Individual
MR. JACK BERNARD HANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
52 VAN HORN LN, STAFFORD, VA 22556-1218
(540) 779-4875
Mailing address
52 VAN HORN LN, STAFFORD, VA 22556-1218
(540) 779-4875
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
VA
Other
Enumeration date
02/23/2026
Last updated
02/23/2026
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