Provider Demographics
NPI:1629281522
Name:HACKLEY, NONA JEAN
Entity Type:Individual
Prefix:MRS
First Name:NONA
Middle Name:JEAN
Last Name:HACKLEY
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 1:2577 TECUMSEH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-3162
Mailing Address - Country:US
Mailing Address - Phone:937-360-2789
Mailing Address - Fax:
Practice Address - Street 1:2577 TECUMSEH AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-3162
Practice Address - Country:US
Practice Address - Phone:937-360-2789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2593028Medicaid