Healthcare Provider Details

I. General information

NPI: 1033770789
Provider Name (Legal Business Name): CHARITY HANSFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 03/25/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 S 5TH AVE
CLARION PA
16214-8676
US

IV. Provider business mailing address

155 STRAWBERRY FARM RD
KNOX PA
16232-3659
US

V. Phone/Fax

Practice location:
  • Phone: 814-223-9280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW010539
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: