Healthcare Provider Details

I. General information

NPI: 1982165379
Provider Name (Legal Business Name): HEATHER A HANNING LM,CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 TENNESSEE ST STE U
REDLANDS CA
92373-8159
US

IV. Provider business mailing address

PO BOX 1789
CRESTLINE CA
92325-1789
US

V. Phone/Fax

Practice location:
  • Phone: 909-839-3840
  • Fax:
Mailing address:
  • Phone: 909-838-3840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: