Provider Demographics
NPI:1407414758
Name:DAVIDHIZAR, HANNAH NICOLE
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:NICOLE
Last Name:DAVIDHIZAR
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 1:9600 26TH ST S
Mailing Address - Street 2:
Mailing Address - City:SCOTTS
Mailing Address - State:MI
Mailing Address - Zip Code:49088-7733
Mailing Address - Country:US
Mailing Address - Phone:269-626-6067
Mailing Address - Fax:
Practice Address - Street 1:1750 GRAND RIDGE CT NE STE 200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7043
Practice Address - Country:US
Practice Address - Phone:616-426-9034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-02
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIFLV843559110OtherBLUE CROSS BLUE SHIELD