Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 71007069A | IN |
NPI | 1023476272 |
---|---|
Provider Name | Mrs. Karla Joann Hanson |
First Address | Valparaiso, AZ 46383 |
Second Address | Valparaiso, IN 46383-2800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2016 |
Last Update Date | 19/10/2020 |