Healthcare Provider Details

I. General information

NPI: 1588475248
Provider Name (Legal Business Name): HANNAH JOELLE CIFUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH JOELLE DECKER

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 CHARLTON HOUSE WAY
FREDERICK MD
21702-2608
US

IV. Provider business mailing address

255 E PACES FERRY RD NE
ATLANTA GA
30305-2233
US

V. Phone/Fax

Practice location:
  • Phone: 304-820-4598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR191571
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: