Individual
MINA ADEL HANALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, ATC
Contact information
Practice address
1000 HEALTH CENTER DR, MATTOON, IL 61938-4644
(217) 258-2525
Mailing address
PO BOX 372, MATTOON, IL 61938-0372
(217) 868-2812
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
096004942
IL
363A00000X
Physician Assistant
Primary
085-009956
IL
Other
Enumeration date
08/13/2019
Last updated
10/11/2023
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