1043251226 NPI number — MICHELE HANNON CRNA

Table of content: MICHELE HANNON CRNA (NPI 1043251226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043251226 NPI number — MICHELE HANNON CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANNON
Provider First Name:
MICHELE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043251226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 SAINT JOHNSBURY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03561-3442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-444-9000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 SAINT JOHNSBURY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03561-3442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-444-9000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  053547-23-11 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , with the licence number: RN266324L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1011108 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2197483 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 80300008 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 40Y008318NH01 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 68381 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: P64615 . This is a "HARVARD PILGRIM HEALTHCAR" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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