Provider Demographics
NPI:1194441113
Name:JAZDZEWSKI, HANNAH OLIVIA (MSN, AGPCNP)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:OLIVIA
Last Name:JAZDZEWSKI
Suffix:
Gender:F
Credentials:MSN, AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 HALDEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2031
Mailing Address - Country:US
Mailing Address - Phone:859-704-0440
Mailing Address - Fax:
Practice Address - Street 1:4001 KRESGE WAY STE 236
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4640
Practice Address - Country:US
Practice Address - Phone:502-893-7372
Practice Address - Fax:502-409-4715
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018504363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health