Healthcare Provider Details

I. General information

NPI: 1679410567
Provider Name (Legal Business Name): HANNAH GRACE CRUZ KOLASINSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH GRACE CRUZ

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W FOREST AVE FL 5
JACKSON TN
38301-3937
US

IV. Provider business mailing address

203 LAKE LIDA LN
ROCHELLE IL
61068-8800
US

V. Phone/Fax

Practice location:
  • Phone: 731-541-3755
  • Fax:
Mailing address:
  • Phone: 630-429-4734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: