Provider Demographics
NPI:1154047926
Name:COLLAO, HANNAH ROSE
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ROSE
Last Name:COLLAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 DOVER AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-5858
Mailing Address - Country:US
Mailing Address - Phone:815-768-5317
Mailing Address - Fax:
Practice Address - Street 1:55 DOVER AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-5858
Practice Address - Country:US
Practice Address - Phone:815-768-5317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2022067279363LA2100X
IL041413419163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WX0200XNursing Service ProvidersRegistered NurseOncology