Healthcare Provider Details

I. General information

NPI: 1497494470
Provider Name (Legal Business Name): HANNAH CLOUGH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE STE 902
ALEXANDRIA VA
22304-1306
US

IV. Provider business mailing address

3017 N PERSHING DR
ARLINGTON VA
22201-1627
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-4300
  • Fax:
Mailing address:
  • Phone: 401-793-1568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024184157
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: