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General NPI Number Information
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NPI Number | 1154339935
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Entity Type | Individual
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Provider Name | LAURA A HANNON MD
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Gender | Female
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 09/18/2020
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Provider Practice Location Address
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Address Line | 8988 E US HIGHWAY 20
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City | NEW CARLISLE
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State | IN
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Zip | 46552-9038
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Country | US
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Telephone | 574-654-7779
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Fax | 574-654-7780
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Provider Business Mailing Address
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Address Line | 2022 KELLE DR
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City | CHESTERTON
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State | IN
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Zip | 46304-8708
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Country | US
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Telephone | 219-326-2312
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Fax | 219-326-2584
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01061101A
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License Number State | IN
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