Healthcare Provider Details

I. General information

NPI: 1053609487
Provider Name (Legal Business Name): MICHAEL SHAWN HANER D.O.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 EARLY ST.
SANTA FE NM
87501
US

IV. Provider business mailing address

PO BOX 32431
SANTA FE NM
87594-2431
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-5117
  • Fax:
Mailing address:
  • Phone: 505-660-9058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1006
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: