Provider Demographics
NPI:1083953368
Name:LANDIS, HANNAH E (CPM, CDEM, IBCLC)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:E
Last Name:LANDIS
Suffix:
Gender:F
Credentials:CPM, CDEM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 BATESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-5363
Mailing Address - Country:US
Mailing Address - Phone:309-532-2841
Mailing Address - Fax:
Practice Address - Street 1:2232 BATESTOWN RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5363
Practice Address - Country:US
Practice Address - Phone:309-532-2841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X, 374J00000X
IN90000020A176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula