Provider Demographics
NPI:1699924704
Name:MANN, HANNAH GUESS (CNM)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:GUESS
Last Name:MANN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 TILLETT RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-4102
Mailing Address - Country:US
Mailing Address - Phone:540-537-1131
Mailing Address - Fax:540-989-6592
Practice Address - Street 1:3524 BRAMBLETON AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6528
Practice Address - Country:US
Practice Address - Phone:540-537-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164234367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7790112Medicaid