Provider Demographics
NPI:1396015848
Name:HANNA, KRISY L (RN)
Entity Type:Individual
Prefix:
First Name:KRISY
Middle Name:L
Last Name:HANNA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1526
Mailing Address - Country:US
Mailing Address - Phone:231-924-4200
Mailing Address - Fax:231-924-4064
Practice Address - Street 1:230 W OAK ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1526
Practice Address - Country:US
Practice Address - Phone:231-924-4200
Practice Address - Fax:231-924-4064
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704275998163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F26007Medicare PIN