Provider Demographics
NPI:1760557938
Name:HANFF, JANET ELIZABETH (PA)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:ELIZABETH
Last Name:HANFF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 N MICHIGAN ST
Practice Address - Street 2:STE 306
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1077
Practice Address - Country:US
Practice Address - Phone:574-647-6500
Practice Address - Fax:574-647-6518
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000248A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300006350Medicaid
IN000000878297OtherBCBS BMG CARDIOTHORACIC ELKHART
INP01073274OtherRR MEDICARE
R97494Medicare UPIN
INM400061608Medicare PIN
INP01073274OtherRR MEDICARE