Provider Demographics
NPI:1003572322
Name:PRATER, HANNAH ALYCE (FNP-C)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:ALYCE
Last Name:PRATER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 BRENTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549-1115
Mailing Address - Country:US
Mailing Address - Phone:217-254-3353
Mailing Address - Fax:
Practice Address - Street 1:241 W WEAVER RD STE 145C
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535-9767
Practice Address - Country:US
Practice Address - Phone:217-876-5200
Practice Address - Fax:217-876-5206
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.023790207Q00000X
IL209010664363LF0000X
IL209023790363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine