Provider Demographics
NPI:1952052854
Name:JOHANSEN, HANNA REBECCA
Entity Type:Individual
Prefix:MS
First Name:HANNA
Middle Name:REBECCA
Last Name:JOHANSEN
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 1:3990 GIBBS DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-8790
Mailing Address - Country:US
Mailing Address - Phone:612-814-2635
Mailing Address - Fax:
Practice Address - Street 1:1175 N GUIGNARD DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1519
Practice Address - Country:US
Practice Address - Phone:803-934-4395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist