Provider Demographics
NPI:1972101764
Name:HANNA, MICHELLE ELSIABETH (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELSIABETH
Last Name:HANNA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7705 SAXON DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2834
Mailing Address - Country:US
Mailing Address - Phone:256-683-9252
Mailing Address - Fax:
Practice Address - Street 1:1212 PRESIDENTS WAY SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-3673
Practice Address - Country:US
Practice Address - Phone:256-683-9252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA809230163W00000X
AL1-118594367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse