Provider Demographics
NPI:1215303243
Name:EHALT, HANNAH
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:EHALT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8290 KENNEDY CT
Mailing Address - Street 2:
Mailing Address - City:ST BONIFACIUS
Mailing Address - State:MN
Mailing Address - Zip Code:55375-1207
Mailing Address - Country:US
Mailing Address - Phone:612-306-8729
Mailing Address - Fax:
Practice Address - Street 1:8290 KENNEDY CT
Practice Address - Street 2:
Practice Address - City:ST BONIFACIUS
Practice Address - State:MN
Practice Address - Zip Code:55375-1207
Practice Address - Country:US
Practice Address - Phone:612-306-8729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR224488-0163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse