Individual
MICHELE HANNAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
PLAINS REGIONAL MEDICAL GROUP, 2200 W 21ST ST, CLOVIS, NM 88101
(575) 769-7577
(575) 769-7595
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A-112799
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71706
—
NM
Enumeration date
10/03/2006
Last updated
08/14/2008
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