Basic Information
| Provider Information | |||||||||
| NPI: | 1922121870 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANNAFORD | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3911 W CLARA LN | ||||||||
| Address2: | US HEALTH WORKS | ||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473045412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652888800 | ||||||||
| FaxNumber: | 7657512278 | ||||||||
| Practice Location | |||||||||
| Address1: | 3911 W CLARA LN | ||||||||
| Address2: | US HEALTH WORKS | ||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473045412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652888800 | ||||||||
| FaxNumber: | 7657512278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2007 | ||||||||
| LastUpdateDate: | 08/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 10000922A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.