Provider Demographics
NPI:1881308740
Name:GUILLIAMS, HANNAH ELISABETH
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ELISABETH
Last Name:GUILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ARROWWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SUMERCO
Mailing Address - State:WV
Mailing Address - Zip Code:25567-9622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1563 SAND PLANT RD
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-6120
Practice Address - Country:US
Practice Address - Phone:043-756-1500
Practice Address - Fax:304-756-1548
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WV2929363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program