MEDICARE: MRS. JENNIE P HIAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	71000431	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000328971	OTHER		ANTHEM BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	351791786104	OTHER	IN	CARESOURCE PROVIDER ID

General Provider Information

NPI Number	:	1144229295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIE P HIAM

Provider Business Mailing Address
First Line	:	501 JOHN ST
Second Line	:	SUITE 12
City	:	EVANSVILLE
State	:	IN
Zip	:	47713-2705
Country	:	US
Telephone Number	:	812-421-7489
Fax Number	:	812-421-7494

Provider Business Practice Location Address
First Line	:	907 SE 8TH ST
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47713-1530
Country	:	US
Telephone Number	:	812-436-0224
Fax Number	:	812-436-0230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	03/26/2010

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Directions to “ MRS. JENNIE P HIAM ” Practice Location

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