Individual
MALLORY HANEWICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
3988 W STATE ROAD 10, WHEATFIELD, IN 46392-9251
(219) 987-3581
Mailing address
7402 N 400 W, RENSSELAER, IN 47978-7528
(219) 869-3675
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71015853A
IN
Other
Enumeration date
10/17/2024
Last updated
10/17/2024
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