Provider Demographics
NPI:1245466416
Name:HANAWAY, ANNIE C (ND)
Entity type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:C
Last Name:HANAWAY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 SW 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-1719
Mailing Address - Country:US
Mailing Address - Phone:503-236-7578
Mailing Address - Fax:313-772-8773
Practice Address - Street 1:5720 SW 52ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-1719
Practice Address - Country:US
Practice Address - Phone:503-236-7578
Practice Address - Fax:313-772-8773
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1167175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath