Provider Demographics
NPI:1821447509
Name:HACKER, LORIE LEE (NP-C)
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:LEE
Last Name:HACKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 GAME BIRD DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-7324
Mailing Address - Country:US
Mailing Address - Phone:317-828-1540
Mailing Address - Fax:
Practice Address - Street 1:10 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-1230
Practice Address - Country:US
Practice Address - Phone:317-736-0055
Practice Address - Fax:317-739-3505
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006593A363LG0600X
IN28144309A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology