Individual
AUTUMN MARIE HANNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
211 N EDDY ST, SOUTH BEND, IN 46617-2808
(574) 234-8161
Mailing address
26621 HAMILTON ST, EDWARDSBURG, MI 49112-9691
(574) 855-9892
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300090479
—
IN
Enumeration date
01/18/2024
Last updated
08/19/2025
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