Provider Demographics
NPI:1164154845
Name:NAQUIN, HANNAH BIRDSALL
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:BIRDSALL
Last Name:NAQUIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1359 PINEBLUFF RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4729
Mailing Address - Country:US
Mailing Address - Phone:985-258-7942
Mailing Address - Fax:
Practice Address - Street 1:190 MORAVIAN WAY DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3216
Practice Address - Country:US
Practice Address - Phone:336-767-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist