Provider Demographics
NPI:1740203538
Name:HANSEN, SUZANNE
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:HANSEN
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 1:8040 CLEARVISTA PKWY
Mailing Address - Street 2:SUITE 520
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-5630
Mailing Address - Country:US
Mailing Address - Phone:317-621-2400
Mailing Address - Fax:
Practice Address - Street 1:8040 CLEARVISTA PKWY
Practice Address - Street 2:SUITE 520
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5630
Practice Address - Country:US
Practice Address - Phone:317-621-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059112A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000329517OtherANTHEM
INP00241909OtherRR MEDICARE
INH18706Medicare UPIN
IN216810BMedicare PIN