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NPI Code Detail

MEDICARE: RONALD JOSEPH HACKER FNP-C

MEDICARE: RONALD JOSEPH HACKER FNP-C
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
1363LF0000XFamily Nurse Practitioner28200453AIN

General Provider Information

NPI Number : 1558940155
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD JOSEPH HACKER FNP-C
Provider Business Mailing Address
First Line : 10847 E GREENDALE DR
Second Line :
City : SEYMOUR
State : IN
Zip : 47274-8550
Country : US
Telephone Number : 812-767-5828
Fax Number :
Provider Business Practice Location Address
First Line : 6125 INWOOD DR
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-5698
Country : US
Telephone Number : 317-559-2309
Fax Number : 833-963-2211
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2021
Last Update Date : 04/25/2022

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