Healthcare Provider Details

I. General information

NPI: 1740878404
Provider Name (Legal Business Name): HANNAH ELIZABETH BARNES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3097 PRAIRIE ST SW
GRANDVILLE MI
49418-2000
US

IV. Provider business mailing address

3016 KNAPP ST NE APT 1G
GRAND RAPIDS MI
49525-4511
US

V. Phone/Fax

Practice location:
  • Phone: 616-531-9973
  • Fax:
Mailing address:
  • Phone: 734-771-4784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4704342913
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: