Healthcare Provider Details

I. General information

NPI: 1285036749
Provider Name (Legal Business Name): RACHEL KIRSTIN HANNA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4857 VIOLET LN
MADISON WI
53714-2126
US

IV. Provider business mailing address

4857 VIOLET LN
MADISON WI
53714-2126
US

V. Phone/Fax

Practice location:
  • Phone: 608-963-6867
  • Fax:
Mailing address:
  • Phone: 608-963-6867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number154837-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number154837-30
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number154837-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: