Healthcare Provider Details

I. General information

NPI: 1336693407
Provider Name (Legal Business Name): HANNAH ISLA NORDWALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2016
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 PINION DR
USAF ACADEMY CO
80840-2502
US

IV. Provider business mailing address

103 N 11TH AVE STE 106B
SAINT CHARLES IL
60174-2291
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-5177
  • Fax:
Mailing address:
  • Phone: 630-488-1935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number149.019062
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: