Healthcare Provider Details

I. General information

NPI: 1366352072
Provider Name (Legal Business Name): HANNAH MARIE VAIDEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5666 E STATE ST
ROCKFORD IL
61108-2425
US

IV. Provider business mailing address

1917 KINGS HWY
ROCKFORD IL
61107-1356
US

V. Phone/Fax

Practice location:
  • Phone: 815-226-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number041.514377
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209036563
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: