Provider Demographics
NPI:1962866749
Name:LEAVITT, HANNAH ELAINE (AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:ELAINE
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 W MADISON ST STE 3825
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4500
Mailing Address - Country:US
Mailing Address - Phone:312-219-2230
Mailing Address - Fax:
Practice Address - Street 1:733 S WELLS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4507
Practice Address - Country:US
Practice Address - Phone:312-765-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014125363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care