Basic Information
| Provider Information | |||||||||
| NPI: | 1114406196 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARTNETT | ||||||||
| FirstName: | HANNAH | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6626 E 75TH ST STE 500 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176217588 | ||||||||
| FaxNumber: | 3179572749 | ||||||||
| Practice Location | |||||||||
| Address1: | 7250 CLEARVISTA DR STE 355 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462565609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176215676 | ||||||||
| FaxNumber: | 3176215678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2018 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 10002505A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | P02110483 | 01 | IN | MEDICARE RR | OTHER | 266180C19 | 01 | IN | TRADITIONAL MEDICARE | OTHER | 300017505 | 05 | IN | MEDICAID |