Provider Demographics
NPI:1790750990
Name:HANNON, SARA BETH (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BETH
Last Name:HANNON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:BETH
Other - Last Name:HILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 775985
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5985
Mailing Address - Country:US
Mailing Address - Phone:317-770-6900
Mailing Address - Fax:317-770-6911
Practice Address - Street 1:325 WESTFIELD RD STE C
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1496
Practice Address - Country:US
Practice Address - Phone:317-770-1700
Practice Address - Fax:317-770-1727
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000570A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400062413Medicare PIN
IN221620AMedicare PIN
INP77900Medicare UPIN