Healthcare Provider Details

I. General information

NPI: 1467016477
Provider Name (Legal Business Name): STEPHANIE HAHN RN, MSN, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVE
MINNEAPOLIS MN
55404
US

IV. Provider business mailing address

721 N 1ST ST APT 510
MINNEAPOLIS MN
55401-4409
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-6000
  • Fax:
Mailing address:
  • Phone: 262-352-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number6798
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: