Healthcare Provider Details

I. General information

NPI: 1942127261
Provider Name (Legal Business Name): DR. HANNAH CATHERINE STUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5165 NORTHLAND DR NE
GRAND RAPIDS MI
49525-1015
US

IV. Provider business mailing address

420 ALABAMA AVE NW APT 227
GRAND RAPIDS MI
49504-5709
US

V. Phone/Fax

Practice location:
  • Phone: 616-386-1840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704363899
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: