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General NPI Number Information
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NPI Number | 1558940155
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Entity Type | Individual
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Provider Name | RONALD JOSEPH HACKER FNP-C
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Gender | Male
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 6125 INWOOD DR
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City | COLUMBUS
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State | IN
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Zip | 47201-5698
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Country | US
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Telephone | 317-559-2309
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Fax | 833-963-2211
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Provider Business Mailing Address
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Address Line | 10847 E GREENDALE DR
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City | SEYMOUR
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State | IN
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Zip | 47274-8550
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Country | US
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Telephone | 812-767-5828
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28200453A
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License Number State | IN
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