Provider Demographics
NPI:1477036358
Name:HAHN, ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HAHN
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 1:403 S RED SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-6278
Mailing Address - Country:US
Mailing Address - Phone:612-799-9688
Mailing Address - Fax:
Practice Address - Street 1:1210 W 18TH ST STE G01
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-4651
Practice Address - Country:US
Practice Address - Phone:605-328-2663
Practice Address - Fax:605-328-3760
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001436363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner