Healthcare Provider Details

I. General information

NPI: 1396151478
Provider Name (Legal Business Name): DORICE HANKEMEIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BALL STATE UNIVERSITY, HP 328
MUNCIE IN
47306
US

IV. Provider business mailing address

BALL STATE UNIVERSITY, HP 328
MUNCIE IN
47306
US

V. Phone/Fax

Practice location:
  • Phone: 765-285-2637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001036A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: