Provider Demographics
NPI:1932975893
Name:HANNUM, CHRISTIE
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:HANNUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:1076 WESTWATER CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:CISCO
Mailing Address - State:UT
Mailing Address - Zip Code:84515
Mailing Address - Country:US
Mailing Address - Phone:970-888-1890
Mailing Address - Fax:
Practice Address - Street 1:510 BUTLER AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-9991
Practice Address - Country:US
Practice Address - Phone:304-263-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6577246QM0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMicrobiology