Provider Demographics
NPI:1770936866
Name:HAHN, ROBERTA SUE (NP)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:SUE
Last Name:HAHN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 W DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8516
Mailing Address - Country:US
Mailing Address - Phone:989-513-3885
Mailing Address - Fax:
Practice Address - Street 1:224 N MILL ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MI
Practice Address - Zip Code:48880-1523
Practice Address - Country:US
Practice Address - Phone:989-303-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704203280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily