MEDICARE: HANNAH KEENER WHNP

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	163WW0101X	Ambulatory Women's Health Care Registered Nurse	28205585A	IN
2	363LW0102X	Women's Health Nurse Practitioner	28205585A	IN

General Provider Information

NPI Number	:	1194238667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH KEENER WHNP

Provider Business Mailing Address
First Line	:	200 S MERIDIAN ST STE 400
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46225-1076
Country	:	US
Telephone Number	:	317-637-4343
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 FRANKLIN ST
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-4562
Country	:	US
Telephone Number	:	219-872-7215
Fax Number	:

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

Provider Enumeration Date	:	11/07/2017
Last Update Date	:	11/07/2017

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