Provider Demographics
NPI:1760637797
Name:FOLLETT, HANNAH KATHERINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:KATHERINE
Last Name:FOLLETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:HANNAH
Other - Middle Name:KATHERINE
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3860 W OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-2460
Mailing Address - Country:US
Mailing Address - Phone:872-588-3000
Mailing Address - Fax:872-588-3001
Practice Address - Street 1:3860 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-2460
Practice Address - Country:US
Practice Address - Phone:872-588-3000
Practice Address - Fax:872-588-3001
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003401363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085003401OtherSTATE LICENSE
IL1083756OtherSPECIALTY BOARDS
IL385002224OtherCS LICENSE
IL385002224OtherCS LICENSE