Provider Demographics
NPI:1245989797
Name:HANNON, RACHELLE MARIE (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:MARIE
Last Name:HANNON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E 150 S
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-9655
Mailing Address - Country:US
Mailing Address - Phone:219-242-1113
Mailing Address - Fax:
Practice Address - Street 1:1354 S LAKE PARK AVE STE B
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-5964
Practice Address - Country:US
Practice Address - Phone:219-945-4495
Practice Address - Fax:219-703-6701
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012275A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15521982OtherCAQH
IN300060867Medicaid