Provider Demographics
NPI:1750826343
Name:BADER, HANNAH JO (PA)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:JO
Last Name:BADER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 WASHINGTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5848
Mailing Address - Country:US
Mailing Address - Phone:989-892-5664
Mailing Address - Fax:
Practice Address - Street 1:248 WASHINGTON AVE STE A
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5848
Practice Address - Country:US
Practice Address - Phone:989-892-5664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008059363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1750826343Medicaid