Provider Demographics
NPI:1255861738
Name:WANSITLER, HANNAH LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:LOUISE
Last Name:WANSITLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:LOUISE
Other - Last Name:ROLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4272 W VIENNA RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-9501
Mailing Address - Country:US
Mailing Address - Phone:248-722-0483
Mailing Address - Fax:
Practice Address - Street 1:4272 W VIENNA RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-9501
Practice Address - Country:US
Practice Address - Phone:810-919-9415
Practice Address - Fax:810-686-1687
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical