Provider Demographics
NPI:1285647792
Name:HANNA, NANCY M (PAC)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:M
Last Name:HANNA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SPARKS AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130
Mailing Address - Country:US
Mailing Address - Phone:812-218-8555
Mailing Address - Fax:812-218-8557
Practice Address - Street 1:207 SPARKS AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130
Practice Address - Country:US
Practice Address - Phone:812-218-8555
Practice Address - Fax:812-218-8557
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000146A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000108197OtherANTHEM
IN000000108197OtherANTHEM
S85158Medicare UPIN