Provider Demographics
NPI:1750719605
Name:LAX, HANNAH V (FNP)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:V
Last Name:LAX
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:LEIGH
Other - Last Name:VISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:901-227-7015
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:1020 E REELFOOT AVE STE 100
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5801
Practice Address - Country:US
Practice Address - Phone:731-885-5100
Practice Address - Fax:731-885-7584
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17913363LX0001X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology