NPI Code Detail JSON Logo

1679908552 NPI number — ANGELA MICHELLE HANNAH PA-C

NPI Number: 1679908552
Health Care Provider/Practitioner: ANGELA MICHELLE HANNAH PA-C

Information about “1679908552” NPI (ANGELA MICHELLE HANNAH PA-C) exists in 1679908552 in HTML format HTML  |  1679908552 in plain Text format TXT  |  1679908552 in PDF (Portable Document Format) PDF  |  1679908552 in an XML format XML  formats.

NPI Number : 1679908552 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679908552",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HANNAH",
    "FirstName": "ANGELA",
    "MiddleName": "MICHELLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DERRICK",
    "OtherFirstName": "ANGELA",
    "OtherMiddleName": "MICHELLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "100 MICHIGAN ST NE",
    "SecondLineMailingAddress": "MC 845",
    "MailingAddressCityName": "GRAND RAPIDS",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49503-2560",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "78 N DIVISION ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HESPERIA",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49421-5100",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "231-854-6415",
    "PracticeLocationAddressFaxNumber": "231-854-6975",
    "EnumerationDate": "09/10/2013",
    "LastUpdateDate": "03/30/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "5601006764",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2025 Data Labs Health. All rights reserved.