Individual
LAURA A HANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8988 E US HIGHWAY 20, NEW CARLISLE, IN 46552-9038
(574) 654-7779
(574) 654-7780
Mailing address
2022 KELLE DR, CHESTERTON, IN 46304-8708
(219) 326-2312
(219) 326-2584
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01061101A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000378303
ANTHEM, BCBS
IN
05
—
200529120A
—
IN
Enumeration date
08/04/2006
Last updated
09/18/2020
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