Provider Demographics
NPI:1407652431
Name:HANNON, LISA MARIE (MSN APRN WHNP-BC)
Entity type:Individual
Prefix:MS
First Name:LISA MARIE
Middle Name:
Last Name:HANNON
Suffix:
Gender:
Credentials:MSN APRN WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5892 HIDDEN OAK AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-8214
Mailing Address - Country:US
Mailing Address - Phone:210-710-1926
Mailing Address - Fax:
Practice Address - Street 1:5892 HIDDEN OAK AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083-8214
Practice Address - Country:US
Practice Address - Phone:210-710-1926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704398724363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health