Provider Demographics
NPI:1720722622
Name:COLSTROM, HANNAH JESSE (AGPCNP)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:JESSE
Last Name:COLSTROM
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBO
Mailing Address - State:KS
Mailing Address - Zip Code:66856-9351
Mailing Address - Country:US
Mailing Address - Phone:785-806-7746
Mailing Address - Fax:
Practice Address - Street 1:634 SW MULVANE ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1678
Practice Address - Country:US
Practice Address - Phone:785-295-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS80713363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology