1326203720 NPI number — MS. HEATHER DAWN HANNAH ANP

Table of content: MS. HEATHER DAWN HANNAH ANP (NPI 1326203720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326203720 NPI number — MS. HEATHER DAWN HANNAH ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANNAH
Provider First Name:
HEATHER
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON
Provider Other First Name:
HEATHER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326203720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3101 SE 14TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENTONVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72712-4900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-986-6090
Provider Business Mailing Address Fax Number:
479-986-6250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 SE 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTONVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-986-6090
Provider Business Practice Location Address Fax Number:
479-986-6250
Provider Enumeration Date:
07/24/2008

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: 363LF0000X , with the licence number:  A03138 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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