Provider Demographics
NPI:1437040920
Name:WAGGONER, HANNAH RENEE
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:RENEE
Last Name:WAGGONER
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 1:1675 CHRISTOPHER WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81503-4415
Mailing Address - Country:US
Mailing Address - Phone:970-615-0190
Mailing Address - Fax:
Practice Address - Street 1:1130 BELFORD AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3137
Practice Address - Country:US
Practice Address - Phone:970-462-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor