Provider Demographics
NPI:1922121870
Name:HANNAFORD, JOHN MARK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MARK
Last Name:HANNAFORD
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3911 W CLARA LN
Mailing Address - Street 2:US HEALTH WORKS
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5412
Mailing Address - Country:US
Mailing Address - Phone:765-288-8800
Mailing Address - Fax:765-751-2278
Practice Address - Street 1:3911 W CLARA LN
Practice Address - Street 2:US HEALTH WORKS
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5412
Practice Address - Country:US
Practice Address - Phone:765-288-8800
Practice Address - Fax:765-751-2278
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2014-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN10000922A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant