Provider Demographics
NPI:1598474694
Name:WILSON, HANNA
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:WILSON
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 1:265 COUNTY ROAD 1272
Mailing Address - Street 2:
Mailing Address - City:VINEMONT
Mailing Address - State:AL
Mailing Address - Zip Code:35179-5744
Mailing Address - Country:US
Mailing Address - Phone:256-590-8878
Mailing Address - Fax:
Practice Address - Street 1:265 COUNTY ROAD 1272
Practice Address - Street 2:
Practice Address - City:VINEMONT
Practice Address - State:AL
Practice Address - Zip Code:35179-5744
Practice Address - Country:US
Practice Address - Phone:256-590-8878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-172502163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse