Individual
TODD W HANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2002 S 11TH ST, NILES, MI 49120-4074
(269) 687-0200
(269) 684-0199
Mailing address
2002 S 11TH ST, NILES, MI 49120-4074
(269) 687-0200
(269) 684-0199
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704242509
MI
363L00000X
Nurse Practitioner
71007785A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300010736
—
IN
Enumeration date
08/13/2013
Last updated
08/15/2023
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