Provider Demographics
NPI:1215760053
Name:MARTIN, HANNAH (BA, CHW)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BA, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 LOGAN ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5348
Mailing Address - Country:US
Mailing Address - Phone:616-915-0152
Mailing Address - Fax:
Practice Address - Street 1:2100 RAYBROOK ST SE STE 203
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5783
Practice Address - Country:US
Practice Address - Phone:616-278-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker