Provider Demographics
NPI:1871535740
Name:HANNA, ELBERT LELAND II (LPN)
Entity type:Individual
Prefix:MR
First Name:ELBERT
Middle Name:LELAND
Last Name:HANNA
Suffix:II
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7304 FIELDSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-3182
Mailing Address - Country:US
Mailing Address - Phone:440-224-3095
Mailing Address - Fax:
Practice Address - Street 1:7304 FIELDSTONE AVE
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-3182
Practice Address - Country:US
Practice Address - Phone:440-224-3095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 109599164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2341068Medicaid