Healthcare Provider Details

I. General information

NPI: 1225805187
Provider Name (Legal Business Name): CHRISTOPHER A HANES PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W PATRICK ST
FREDERICK MD
21701-4027
US

IV. Provider business mailing address

611 W PATRICK ST
FREDERICK MD
21701-4027
US

V. Phone/Fax

Practice location:
  • Phone: 240-439-4900
  • Fax:
Mailing address:
  • Phone: 240-439-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR207189
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024025296
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: