Provider Demographics
NPI:1043251226
Name:HANNON, MICHELE (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:HANNON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SAINT JOHNSBURY RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-3442
Mailing Address - Country:US
Mailing Address - Phone:603-444-9000
Mailing Address - Fax:
Practice Address - Street 1:600 SAINT JOHNSBURY RD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-3442
Practice Address - Country:US
Practice Address - Phone:603-444-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH053547-23-11367500000X
PARN266324L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011108Medicaid
NH2197483OtherCIGNA HEALTHCARE
NH80300008Medicaid
NH40Y008318NH01OtherBLUE CROSS BLUE SHIELD
VT68381OtherBLUE CROSS BLUE SHIELD
NHP64615OtherHARVARD PILGRIM HEALTHCAR
NHP64615OtherHARVARD PILGRIM HEALTHCAR
NHP64615Medicare UPIN