Healthcare Provider Details

I. General information

NPI: 1003572322
Provider Name (Legal Business Name): HANNAH ALYCE PRATER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 W WEAVER RD STE 145C
FORSYTH IL
62535-9767
US

IV. Provider business mailing address

1605 BRENTWOOD CT
MOUNT ZION IL
62549-1115
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-5200
  • Fax: 217-876-5206
Mailing address:
  • Phone: 217-254-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number209.023790
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209010664
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209023790
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: