Provider Demographics
NPI:1689911836
Name:HAHN, KATHLEEN BETH (PNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BETH
Last Name:HAHN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94592-1177
Mailing Address - Country:US
Mailing Address - Phone:707-556-8921
Mailing Address - Fax:707-556-8826
Practice Address - Street 1:100 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2194
Practice Address - Country:US
Practice Address - Phone:707-556-8921
Practice Address - Fax:707-556-8826
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA517066363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics