Provider Demographics
NPI:1679765754
Name:HIATT, MICHAEL E (CNA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:HIATT
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 WINDHAVEN CIR APT H
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-8093
Mailing Address - Country:US
Mailing Address - Phone:765-277-2804
Mailing Address - Fax:
Practice Address - Street 1:1117 WINDHAVEN CIR APT H
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-8093
Practice Address - Country:US
Practice Address - Phone:765-277-2804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31-03-07-01542374U00000X
IN31-01-07-04508376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide