Provider Demographics
NPI:1336708643
Name:DUBY, HANNAH ROSE (DNP, AGNP-C)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:ROSE
Last Name:DUBY
Suffix:
Gender:F
Credentials:DNP, AGNP-C
Other - Prefix:MS
Other - First Name:HANNAH
Other - Middle Name:ROSE
Other - Last Name:CIESLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:560 W MITCHELL ST STE 400
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2274
Mailing Address - Country:US
Mailing Address - Phone:231-487-2490
Mailing Address - Fax:
Practice Address - Street 1:560 W MITCHELL ST STE 400
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2274
Practice Address - Country:US
Practice Address - Phone:231-487-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704290209363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner