Provider Demographics
NPI:1033646252
Name:PEDERSON, HANNAH (MD)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:PEDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 2ND AVE # 101
Mailing Address - Street 2:
Mailing Address - City:NIWOT
Mailing Address - State:CO
Mailing Address - Zip Code:80544-5004
Mailing Address - Country:US
Mailing Address - Phone:303-652-9222
Mailing Address - Fax:
Practice Address - Street 1:361 2ND AVE # 101
Practice Address - Street 2:
Practice Address - City:NIWOT
Practice Address - State:CO
Practice Address - Zip Code:80544-5004
Practice Address - Country:US
Practice Address - Phone:303-652-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX665475207R00000X
390200000X
CODR.0065965207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program