Healthcare Provider Details

I. General information

NPI: 1053980854
Provider Name (Legal Business Name): HANNAH JANE ANTONI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6081 WEST RIVER DR NE
BELMONT MI
49306-9219
US

IV. Provider business mailing address

2407 COLLEGE AVE NE
GRAND RAPIDS MI
49505-3638
US

V. Phone/Fax

Practice location:
  • Phone: 616-625-0386
  • Fax:
Mailing address:
  • Phone: 989-464-3998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704363969
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704363969
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: