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General NPI Number Information
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NPI Number | 1811789894
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Entity Type | Individual
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Provider Name | KELLY LEE HANNER MSN RN, LMT
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Gender | Female
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 110 ELM ST STE C
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City | BIG RAPIDS
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State | MI
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Zip | 49307-1802
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Country | US
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Telephone | 231-598-9144
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Fax |
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Provider Business Mailing Address
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Address Line | 110 ELM ST STE C
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City | BIG RAPIDS
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State | MI
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Zip | 49307-1802
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Country | US
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Telephone | 231-598-9144
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM1400X
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Taxonomy Name | Nurse Massage Therapist (NMT)
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License Number | 4704280951
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704280951
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 7501016036
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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