Provider Demographics
NPI:1982165379
Name:HANNING, HEATHER A (LM,CPM)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:A
Last Name:HANNING
Suffix:
Gender:F
Credentials:LM,CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1789
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:CA
Mailing Address - Zip Code:92325-1789
Mailing Address - Country:US
Mailing Address - Phone:909-838-3840
Mailing Address - Fax:
Practice Address - Street 1:414 TENNESSEE ST STE U
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8159
Practice Address - Country:US
Practice Address - Phone:909-839-3840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife