Provider Demographics
NPI:1851007496
Name:NICLOU, HANNAH HOJEIJ (NP)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:HOJEIJ
Last Name:NICLOU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:HOJEIJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:745 POPLAR RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1267 HIGHWAY 54 W STE 4100
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2112
Practice Address - Country:US
Practice Address - Phone:770-506-5470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN299548363L00000X, 363L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program