Provider Demographics
NPI:1558940155
Name:HACKER, RONALD JOSEPH (FNP-C)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JOSEPH
Last Name:HACKER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10847 E GREENDALE DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-8550
Mailing Address - Country:US
Mailing Address - Phone:812-767-5828
Mailing Address - Fax:
Practice Address - Street 1:6125 INWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5698
Practice Address - Country:US
Practice Address - Phone:317-559-2309
Practice Address - Fax:833-963-2211
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28200453A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily