Healthcare Provider Details

I. General information

NPI: 1164181210
Provider Name (Legal Business Name): HANNAH NICHOLE OBERST NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. HANNAH NICHOLE STANLEY

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MICHIGAN AVE STE 307
JACKSON MI
49201-1850
US

IV. Provider business mailing address

1100 E MICHIGAN AVE STE 307
JACKSON MI
49201-1850
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-1594
  • Fax: 517-205-1540
Mailing address:
  • Phone: 517-205-1594
  • Fax: 517-205-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704321040
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704321040
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: