Provider Demographics
NPI:1205407368
Name:HAHN, MINDY DAWN
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:DAWN
Last Name:HAHN
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 1:13700 ENGLISH VILLA DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-3938
Mailing Address - Country:US
Mailing Address - Phone:502-254-2361
Mailing Address - Fax:502-254-2432
Practice Address - Street 1:13700 ENGLISH VILLA DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-3938
Practice Address - Country:US
Practice Address - Phone:502-254-2361
Practice Address - Fax:502-254-2432
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1148686163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator