Healthcare Provider Details

I. General information

NPI: 1760557938
Provider Name (Legal Business Name): JANET ELIZABETH HANFF PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N MICHIGAN ST STE 306
SOUTH BEND IN
46601-1077
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-6500
  • Fax: 574-647-6518
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000248A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: