Provider Demographics
NPI:1275884595
Name:HANE, WILLIAM DEREK (BS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DEREK
Last Name:HANE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ESTILL SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37330-4037
Mailing Address - Country:US
Mailing Address - Phone:931-649-3408
Mailing Address - Fax:931-649-3409
Practice Address - Street 1:416 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ESTILL SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37330-4037
Practice Address - Country:US
Practice Address - Phone:931-649-3408
Practice Address - Fax:931-649-3409
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN088893654251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management