Healthcare Provider Details

I. General information

NPI: 1356289326
Provider Name (Legal Business Name): HANNAH ROOT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 12TH STREET CT
DE WITT IA
52742-1225
US

IV. Provider business mailing address

3405 223RD AVE
MAQUOKETA IA
52060-9345
US

V. Phone/Fax

Practice location:
  • Phone: 563-659-6090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA190194
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA190194
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: