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NPI Code Detail

MEDICARE: HANNAH MARIE PEDERSEN

MEDICARE: HANNAH MARIE PEDERSEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant
2363A00000XPhysician Assistant0010-15772NC

General Provider Information

NPI Number : 1053103408
Entity Type Code : Individual
Provider Name (Legal Business Name) : HANNAH MARIE PEDERSEN
Provider Business Mailing Address
First Line : 1000 VINTAGE CREEK DR APT 310
Second Line :
City : RALEIGH
State : NC
Zip : 27607-6198
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3000 NEW BERN AVE
Second Line :
City : RALEIGH
State : NC
Zip : 27610-1231
Country : US
Telephone Number : 919-350-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2025
Last Update Date : 11/05/2025

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Directions to “ HANNAH MARIE PEDERSEN ” Practice Location

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