Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 01038697A | IN |
NPI | 1033165428 |
---|---|
Provider Name | Dr. Kathryn A. Hanlon |
First Address | South Bend, IN 46617-1924 |
Second Address | South Bend, IN 46601-1173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100098910A | (05) | IN |
E14053 | (02) | IN |