Provider Demographics
NPI:1881087922
Name:WILSON, HANNAH MICHELLE SMITH (PA-C)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MICHELLE SMITH
Last Name:WILSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:MICHELLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:171 RAPTOR HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:TIETON
Mailing Address - State:WA
Mailing Address - Zip Code:98947-5500
Mailing Address - Country:US
Mailing Address - Phone:256-714-8489
Mailing Address - Fax:
Practice Address - Street 1:413 N MISSION ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2007
Practice Address - Country:US
Practice Address - Phone:509-662-1955
Practice Address - Fax:509-662-6695
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA 60537351363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant