Provider Demographics
NPI:1528442480
Name:HANNAH, MICHELLE (LM)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HANNAH
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 S LIGHTSEY AVE
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-6536
Mailing Address - Country:US
Mailing Address - Phone:863-393-8597
Mailing Address - Fax:
Practice Address - Street 1:1525 EDGEWATER BEACH DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4737
Practice Address - Country:US
Practice Address - Phone:863-680-2229
Practice Address - Fax:888-299-6337
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW311176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife