Provider Demographics
NPI:1649457839
Name:HANNEMAN, BARBARA ANN (RN)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:HANNEMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:ANN
Other - Last Name:LINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9671 OAK LN
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-8918
Mailing Address - Country:US
Mailing Address - Phone:715-358-1904
Mailing Address - Fax:
Practice Address - Street 1:9671 OAK LN
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-8918
Practice Address - Country:US
Practice Address - Phone:715-358-1904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38334700Medicaid