1376087130 NPI number — LORI ELAINE HANN ATC

Table of content: LORI ELAINE HANN ATC (NPI 1376087130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376087130 NPI number — LORI ELAINE HANN ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANN
Provider First Name:
LORI
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376087130
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 SWEET VALLEY LN
Provider Second Line Business Mailing Address:
APT B3
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47909-8320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-491-0657
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 SWEET VALLEY LN
Provider Second Line Business Practice Location Address:
APT B3
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47909-8320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-491-0657
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)