Provider Demographics
NPI:1669103818
Name:SHIR, HANNAH (CNM)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:SHIR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9208 HART AVE NW
Mailing Address - Street 2:
Mailing Address - City:MAPLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55358-2302
Mailing Address - Country:US
Mailing Address - Phone:612-442-7469
Mailing Address - Fax:
Practice Address - Street 1:16802 145TH AVE
Practice Address - Street 2:
Practice Address - City:MILACA
Practice Address - State:MN
Practice Address - Zip Code:56353-3208
Practice Address - Country:US
Practice Address - Phone:612-442-7469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-201595-4163WL0100X
MN510367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant