Provider Demographics
NPI:1730817958
Name:HANER, ANASTASIA L (CPM, LM)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:L
Last Name:HANER
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 W 5350 S
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6742
Mailing Address - Country:US
Mailing Address - Phone:801-941-1318
Mailing Address - Fax:
Practice Address - Street 1:537 W 5350 S
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-6742
Practice Address - Country:US
Practice Address - Phone:801-941-1318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11912809-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife