Basic Information
| Provider Information | |||||||||
| NPI: | 1528795333 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANAVAN | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | ED.D, RSA, RPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 WORTHINGTON LN | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140869391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165236849 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3040 AMSDELL RD | ||||||||
| Address2: | |||||||||
| City: | HAMBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140755835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166499000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2022 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 243U00000X | 000166 | NY | Y | Technologists, Technicians & Other Technical Service Providers | Radiology Practitioner Assistant |
No ID Information.