Provider Demographics
NPI:1730305467
Name:DANNHAUSEN, JANE ELLEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ELLEN
Last Name:DANNHAUSEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1359 S. RANDOLPH ST.
Mailing Address - Street 2:
Mailing Address - City:GARRETT
Mailing Address - State:IN
Mailing Address - Zip Code:46738
Mailing Address - Country:US
Mailing Address - Phone:260-357-0077
Mailing Address - Fax:260-357-4452
Practice Address - Street 1:1359 S. RANDOLPH ST.
Practice Address - Street 2:
Practice Address - City:GARRETT
Practice Address - State:IN
Practice Address - Zip Code:46738
Practice Address - Country:US
Practice Address - Phone:260-357-0077
Practice Address - Fax:260-357-4452
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001639A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily