Provider Demographics
NPI:1053309351
Name:HANSELL, CATHY M (NP)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:M
Last Name:HANSELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:CATHY
Other - Middle Name:M
Other - Last Name:KRUG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7120 CLEARVISTA DR
Practice Address - Street 2:SUITE 4000
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1621
Practice Address - Country:US
Practice Address - Phone:317-577-7444
Practice Address - Fax:317-577-7443
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001026A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01456871OtherRR MEDICARE
IN000000647935OtherANTHEM
IN200308550Medicaid
INP01456871OtherRR MEDICARE
IN266180IMedicare PIN