Individual
MRS. JENNIE P HIAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
907 SE 8TH ST, EVANSVILLE, IN 47713-1530
(812) 436-0224
(812) 436-0230
Mailing address
501 JOHN ST, SUITE 12, EVANSVILLE, IN 47713-2705
(812) 421-7489
(812) 421-7494
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71000431
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000328971
ANTHEM BC/BS
—
05
—
100465880A
—
IN
01
—
351791786104
CARESOURCE PROVIDER ID
IN
Enumeration date
07/20/2005
Last updated
03/26/2010
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