Healthcare Provider Details

I. General information

NPI: 1720666514
Provider Name (Legal Business Name): HANNAH MAE PUTNAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/01/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 FRAZIER CT STE 1C
GEORGETOWN KY
40324-9026
US

IV. Provider business mailing address

107 FRAZIER CT STE 1C
GEORGETOWN KY
40324-9026
US

V. Phone/Fax

Practice location:
  • Phone: 859-523-8796
  • Fax: 859-523-9426
Mailing address:
  • Phone: 859-523-8796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number266338
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: