Healthcare Provider Details

I. General information

NPI: 1104137900
Provider Name (Legal Business Name): ABBEY HANSEN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE BLVD RM AG 001
INDIANAPOLIS IN
46202-1239
US

IV. Provider business mailing address

950 N MERIDIAN ST STE 500 PROVIDER ENROLLMENT
INDIANAPOLIS IN
46204-3908
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-3886
  • Fax: 317-962-8652
Mailing address:
  • Phone: 317-962-4940
  • Fax: 317-962-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1102
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002385
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10001192A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2496
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: