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NPI Code Detail

MEDICARE: EBONY N HANNAH AGCNS-BC

MEDICARE: EBONY N HANNAH AGCNS-BC
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
1364SG0600XGerontology Clinical Nurse Specialist28204226AIN

General Provider Information

NPI Number : 1861943532
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBONY N HANNAH AGCNS-BC
Provider Business Mailing Address
First Line : 1481 W 10TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2803
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1481 W 10TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2803
Country : US
Telephone Number : 317-988-2411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2016
Last Update Date : 09/21/2017

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