Basic Information
| Provider Information | |||||||||
| NPI: | 1720277601 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HACKMAN | ||||||||
| FirstName: | DONNA | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1234 E DUPONT RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468251545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2603739700 | ||||||||
| FaxNumber: | 2603739740 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 NICHOLAS PLACE | ||||||||
| Address2: | |||||||||
| City: | AVILLA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2608973308 | ||||||||
| FaxNumber: | 2608973650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2007 | ||||||||
| LastUpdateDate: | 03/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 71002502A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 000000549136 | 01 | IN | ANTHEM | OTHER | 000000528690 | 01 | IN | ANTHEM | OTHER | 200879960 | 05 | IN | MEDICAID | 000000548973 | 01 | IN | ANTHEM | OTHER | P00478527 | 01 | IN | RAILROAD MEDICARE | OTHER |