Basic Information
Provider Information | |||||||||
NPI: | 1881784130 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HANLON | ||||||||
FirstName: | SONJA | ||||||||
MiddleName: | K. | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RNFA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2122 E. HIGHLAND AVE | ||||||||
Address2: | SUITE #300 | ||||||||
City: | PHOENIX | ||||||||
State: | AZ | ||||||||
PostalCode: | 850164744 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6025533113 | ||||||||
FaxNumber: | 6026677991 | ||||||||
Practice Location | |||||||||
Address1: | 2122 E. HIGHLAND AVE | ||||||||
Address2: | SUITE #300 | ||||||||
City: | PHOENIX | ||||||||
State: | AZ | ||||||||
PostalCode: | 850164744 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6025533113 | ||||||||
FaxNumber: | 6026677991 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/14/2006 | ||||||||
LastUpdateDate: | 05/31/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | RN133469 | AZ | N |   | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant | 163WX0800X | RN133469 | AZ | Y |   | Nursing Service Providers | Registered Nurse | Orthopedic | 163WX0800X | RN563611 | CA | N |   | Nursing Service Providers | Registered Nurse | Orthopedic |
No ID Information.