Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 71001026A | IN |
NPI | 1053309351 |
---|---|
Provider Name | Cathy M Hansell |
First Address | Indianapolis, IN 46250-2805 |
Second Address | Indianapolis, IN 46256-1621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 02/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000647935 | ANTHEM (01) | IN |
200308550 | (05) | IN |
P01456871 | RR MEDICARE (01) | IN |
P22390 | (02) | IN |