Provider Demographics
NPI:1114797966
Name:KOZLOWSKI, HANNA RAE
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:RAE
Last Name:KOZLOWSKI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:HANNA
Other - Middle Name:RAE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-5503
Mailing Address - Country:US
Mailing Address - Phone:774-217-8091
Mailing Address - Fax:
Practice Address - Street 1:19 FOSTER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1715
Practice Address - Country:US
Practice Address - Phone:508-373-5607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program