Provider Demographics
NPI:1699027664
Name:HANNON, GRACE SUSANNE (LM,CPM)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:SUSANNE
Last Name:HANNON
Suffix:
Gender:F
Credentials:LM,CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27230
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-2201
Mailing Address - Country:US
Mailing Address - Phone:518-265-3046
Mailing Address - Fax:
Practice Address - Street 1:380 ABBY CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6428
Practice Address - Country:US
Practice Address - Phone:518-265-3046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0059176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife