Provider Demographics
NPI:1033824784
Name:BANCROFT, HANNAH (CRNA DNP)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:BANCROFT
Suffix:
Gender:F
Credentials:CRNA DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9911
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-0200
Mailing Address - Country:US
Mailing Address - Phone:208-746-7555
Mailing Address - Fax:208-746-7556
Practice Address - Street 1:700 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3056
Practice Address - Country:US
Practice Address - Phone:208-882-4511
Practice Address - Fax:208-883-6571
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID74985367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered