MEDICARE: HANNAH BURGESS RN, CRNP

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	163W00000X	Registered Nurse	1-173665	AL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1-173665	AL

General Provider Information

NPI Number	:	1801416458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH BURGESS RN, CRNP

Provider Business Mailing Address
First Line	:	1155 16TH AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-4637
Country	:	US
Telephone Number	:	120-561-6183
Fax Number	:

Provider Business Practice Location Address
First Line	:	2090 COLUMBIANA RD STE 4000
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-2158
Country	:	US
Telephone Number	:	205-616-1835
Fax Number	:

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

Provider Enumeration Date	:	04/23/2020
Last Update Date	:	11/04/2021

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