Organization
FAMILY PRACTICE CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIJAH HANNA (PHYSICIAN ASSISTANT)
(570) 293-4933
Entity
Organization
Contact information
Practice address
112 E CHURCH ST, LOCK HAVEN, PA 17745
(570) 293-4933
Mailing address
112 E CHURCH ST, LOCK HAVEN, PA 17745-2008
(570) 293-4933
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000657230
—
PA
Enumeration date
09/29/2005
Last updated
07/26/2018
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