Healthcare Provider Details

I. General information

NPI: 1194238667
Provider Name (Legal Business Name): HANNAH KEENER WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 FRANKLIN ST
MICHIGAN CITY IN
46360-4562
US

IV. Provider business mailing address

200 S MERIDIAN ST STE 400
INDIANAPOLIS IN
46225-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-872-7215
  • Fax:
Mailing address:
  • Phone: 317-637-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number28205585A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number28205585A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: