Healthcare Provider Details

I. General information

NPI: 1407414758
Provider Name (Legal Business Name): HANNAH NICOLE DAVIDHIZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2019
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 PARCHMENT DR SE
GRAND RAPIDS MI
49546-3664
US

IV. Provider business mailing address

1003 PARCHMENT DR SE
GRAND RAPIDS MI
49546-3664
US

V. Phone/Fax

Practice location:
  • Phone: 616-577-8897
  • Fax: 616-577-8897
Mailing address:
  • Phone: 616-577-8897
  • Fax: 616-577-8897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401225143
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: