Provider Demographics
NPI:1851166680
Name:REISDORFF, HANNA M
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:M
Last Name:REISDORFF
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 1:787 BURLINGTON HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-1493
Mailing Address - Country:US
Mailing Address - Phone:813-368-8248
Mailing Address - Fax:
Practice Address - Street 1:1601 E COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5612
Practice Address - Country:US
Practice Address - Phone:360-763-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program