Provider Demographics
NPI:1770028698
Name:WATERS, HANNAH MICHAELA
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:MICHAELA
Last Name:WATERS
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 1:457 N 900 E
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-2537
Mailing Address - Country:US
Mailing Address - Phone:801-850-8570
Mailing Address - Fax:
Practice Address - Street 1:457 N 900 E
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-2537
Practice Address - Country:US
Practice Address - Phone:801-850-8570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-01
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist