Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 28164886A | IN |
NPI | 1184027005 |
---|---|
Provider Name | Mrs. Jillian Marie Hanger |
First Address | Lake Village, IN 46349-9384 |
Second Address | Hobart, IN 46342-6638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2014 |
Last Update Date | 06/10/2014 |