Provider Demographics
NPI:1164181210
Name:OBERST, HANNAH NICHOLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:NICHOLE
Last Name:OBERST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:HANNAH
Other - Middle Name:NICHOLE
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 E MICHIGAN AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1850
Mailing Address - Country:US
Mailing Address - Phone:517-205-1594
Mailing Address - Fax:517-205-1540
Practice Address - Street 1:1100 E MICHIGAN AVE STE 307
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1850
Practice Address - Country:US
Practice Address - Phone:517-205-1594
Practice Address - Fax:517-205-1540
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704321040363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704321040OtherLICENSE