Healthcare Provider Details

I. General information

NPI: 1851437859
Provider Name (Legal Business Name): MELANIE LYNN HANEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 LANCER ST
PORTAGE IN
46368-4488
US

IV. Provider business mailing address

1452 W 73RD PL
MERRILLVILLE IN
46410-4619
US

V. Phone/Fax

Practice location:
  • Phone: 219-764-3600
  • Fax:
Mailing address:
  • Phone: 219-769-6889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002265A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: