Provider Demographics
NPI:1356908198
Name:CONN, HANNA (NP)
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:CONN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HANNA
Other - Middle Name:
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1930 BROADWAY APT 5P
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6940
Mailing Address - Country:US
Mailing Address - Phone:603-560-7845
Mailing Address - Fax:
Practice Address - Street 1:1930 BROADWAY APT 5P
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6940
Practice Address - Country:US
Practice Address - Phone:603-560-7845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2287967363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2287967Medicaid