Basic Information
| Provider Information | |||||||||
| NPI: | 1023547486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STATZ | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | GRACE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4400 W 69TH ST STE 1500 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571088171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053225700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4400 W 69TH ST STE 1500 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571088171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053225700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2017 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0802X | 125070057 | IL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | 2084P0802X | 13303 | SD | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry |
No ID Information.