Healthcare Provider Details

I. General information

NPI: 1477182053
Provider Name (Legal Business Name): HANNAH GRACE JOHNSON MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 RIO LINDO AVE STE 201
CHICO CA
95926-1852
US

IV. Provider business mailing address

1005 W 6TH ST UNIT 4
CHICO CA
95928-6277
US

V. Phone/Fax

Practice location:
  • Phone: 530-715-8004
  • Fax: 530-200-8362
Mailing address:
  • Phone: 847-910-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number62720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: