Healthcare Provider Details

I. General information

NPI: 1134038938
Provider Name (Legal Business Name): HANNAH M KIRKUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE STE 334
MARQUETTE MI
49855-5407
US

IV. Provider business mailing address

1408 AVONDALE ST
SYLVAN LAKE MI
48320-1702
US

V. Phone/Fax

Practice location:
  • Phone: 517-262-1765
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704362039
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: