Provider Demographics
NPI:1629026398
Name:HAHN, DEANNA M (DO)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:M
Last Name:HAHN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:M
Other - Last Name:KNOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:306 ST. JOSEPH DR.
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3506
Mailing Address - Country:US
Mailing Address - Phone:309-663-2354
Mailing Address - Fax:309-663-7645
Practice Address - Street 1:306 ST. JOSEPH DR.
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3506
Practice Address - Country:US
Practice Address - Phone:309-663-2354
Practice Address - Fax:309-663-7645
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094964174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094964Medicaid