Provider Demographics
NPI:1942805197
Name:DETTINGER, HANNA MARIE
Entity Type:Individual
Prefix:MISS
First Name:HANNA
Middle Name:MARIE
Last Name:DETTINGER
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 1:1240 TIMBERBROOK CT
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2855
Mailing Address - Country:US
Mailing Address - Phone:567-288-3321
Mailing Address - Fax:
Practice Address - Street 1:1240 TIMBERBROOK CT
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2855
Practice Address - Country:US
Practice Address - Phone:567-288-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8702319376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker