Provider Demographics
NPI:1245614726
Name:CLARK, HANNAH (NP)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 N WELLNESS DR
Mailing Address - Street 2:BUILDING A SUITE 120 B
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-7264
Mailing Address - Country:US
Mailing Address - Phone:616-399-9522
Mailing Address - Fax:616-399-0416
Practice Address - Street 1:3235 N WELLNESS DR
Practice Address - Street 2:BUILDING A SUITE 120 B
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7264
Practice Address - Country:US
Practice Address - Phone:616-399-9522
Practice Address - Fax:616-399-0416
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704272241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily