Healthcare Provider Details

I. General information

NPI: 1477027969
Provider Name (Legal Business Name): HANNAH NICOLE PERRY ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16021 18TH ST SE
HUNTER ND
58048-9730
US

IV. Provider business mailing address

16021 18TH ST SE
HUNTER ND
58048-9730
US

V. Phone/Fax

Practice location:
  • Phone: 715-307-7298
  • Fax:
Mailing address:
  • Phone: 701-404-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number919-21
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: