Provider Demographics
NPI:1710329180
Name:HAHN, RANDI (FNP)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:HAHN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5835
Mailing Address - Country:US
Mailing Address - Phone:815-741-3532
Mailing Address - Fax:815-741-3736
Practice Address - Street 1:1719 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5835
Practice Address - Country:US
Practice Address - Phone:815-741-3532
Practice Address - Fax:815-741-3736
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily