MEDICARE: CARMYNN LOUISE HATCH NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	7106218A	IN

General Provider Information

NPI Number	:	1912764283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMYNN LOUISE HATCH NP

Provider Business Mailing Address
First Line	:	7229 ABINGTON DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-2757
Country	:	US
Telephone Number	:	260-445-7241
Fax Number	:

Provider Business Practice Location Address
First Line	:	1367 S RANDOLPH ST
Second Line	:
City	:	GARRETT
State	:	IN
Zip	:	46738-1970
Country	:	US
Telephone Number	:	260-357-5174
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	01/23/2025

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