MEDICARE: ROBERTA SUE HAHN NP

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
1	363LF0000X	Family Nurse Practitioner	4704203280	MI

General Provider Information

NPI Number	:	1770936866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA SUE HAHN NP

Provider Business Mailing Address
First Line	:	2280 W DEERFIELD RD
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-8516
Country	:	US
Telephone Number	:	989-513-3885
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 N MILL ST
Second Line	:
City	:	SAINT LOUIS
State	:	MI
Zip	:	48880-1523
Country	:	US
Telephone Number	:	989-303-4101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	11/28/2022

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