Healthcare Provider Details

I. General information

NPI: 1790750990
Provider Name (Legal Business Name): SARA BETH HANNON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA BETH HILLMAN PA-C

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 WESTFIELD RD STE C
NOBLESVILLE IN
46060-1496
US

IV. Provider business mailing address

PO BOX 775985
CHICAGO IL
60677-5985
US

V. Phone/Fax

Practice location:
  • Phone: 317-770-1700
  • Fax: 317-770-1727
Mailing address:
  • Phone: 317-770-6900
  • Fax: 317-770-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000570A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: