Provider Demographics
NPI:1922568948
Name:BEAVER, HANNAH ELAINE (LM CPM)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:ELAINE
Last Name:BEAVER
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 1:1818 BOISE DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-2105
Mailing Address - Country:US
Mailing Address - Phone:432-425-6411
Mailing Address - Fax:
Practice Address - Street 1:1818 BOISE DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-2105
Practice Address - Country:US
Practice Address - Phone:432-425-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99372176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX99372OtherMIDWIFERY LICENSE NUMBER