Healthcare Provider Details

I. General information

NPI: 1477708659
Provider Name (Legal Business Name): CHARLENE DENISE HANNA APRN-CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 W ANN RD STE 100
NORTH LAS VEGAS NV
89031-3842
US

IV. Provider business mailing address

8906 SPANISH RIDGE AVE STE 202
LAS VEGAS NV
89148-1319
US

V. Phone/Fax

Practice location:
  • Phone: 702-438-4692
  • Fax: 702-485-2372
Mailing address:
  • Phone: 702-330-3102
  • Fax: 702-912-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN001092
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPN001092
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: