Provider Demographics
NPI:1982240180
Name:WICHERN, HANNAH (MPH)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:WICHERN
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2179 43RD ST SE APT F6
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3797
Mailing Address - Country:US
Mailing Address - Phone:231-534-4860
Mailing Address - Fax:
Practice Address - Street 1:1345 MONROE AVE NW STE 140
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-4609
Practice Address - Country:US
Practice Address - Phone:616-458-9520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator