Provider Demographics
NPI:1710719059
Name:RICHARDSON, HANNAH NICOLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:NICOLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:NICOLE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1702 WAVERLY DR
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-2955
Mailing Address - Country:US
Mailing Address - Phone:618-339-9099
Mailing Address - Fax:
Practice Address - Street 1:12639 OLD TESSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2711
Practice Address - Country:US
Practice Address - Phone:314-849-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024029053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily