Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 2020017655 | MO |
Y | 207YS0123X | Facial Plastic Surgeon | 2020017655 | MO |
NPI | 1013304914 |
---|---|
Provider Name | Andrea Lee Hanick |
First Address | Saint Louis, MO 63110 |
Second Address | Columbia, MO 65203-5615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2015 |
Last Update Date | 05/08/2021 |