Provider Demographics
NPI:1093530511
Name:QOLAK-WALKER, HANNA
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:QOLAK-WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HANNA
Other - Middle Name:
Other - Last Name:QOLAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:471 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-2007
Mailing Address - Country:US
Mailing Address - Phone:413-733-1431
Mailing Address - Fax:413-732-7075
Practice Address - Street 1:471 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-2007
Practice Address - Country:US
Practice Address - Phone:413-733-1431
Practice Address - Fax:413-732-7075
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN100470164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse