Healthcare Provider Details

I. General information

NPI: 1659543643
Provider Name (Legal Business Name): WILLIAM HANLEY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E DOUGLAS RD STE 200
MISHAWAKA IN
46545-1465
US

IV. Provider business mailing address

5215 HOLY CROSS PKWY
MISHAWAKA IN
46545-1469
US

V. Phone/Fax

Practice location:
  • Phone: 574-335-6060
  • Fax: 574-335-0611
Mailing address:
  • Phone: 574-335-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006238A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: