Provider Demographics
NPI:1992580047
Name:DERAEDT, HANNAH MARIANNE SYBIL (NP)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MARIANNE SYBIL
Last Name:DERAEDT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:MARIANNE SYBIL
Other - Last Name:GILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5640 E 98TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-6612
Mailing Address - Country:US
Mailing Address - Phone:907-460-0494
Mailing Address - Fax:
Practice Address - Street 1:4320 DIPLOMACY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5925
Practice Address - Country:US
Practice Address - Phone:907-460-0494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK132706163W00000X
AK210627363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse