Individual
LISA ANN HANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548
(616) 281-6382
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601008802
MI
Other
Enumeration date
09/11/2018
Last updated
09/11/2018
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