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Individual

JODIE D HANSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1800 N CAPITOL AVE # NPE140, INDIANAPOLIS, IN 46202-1218
(317) 962-8776
(317) 963-5285
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002586A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
068010481
MEDICARE PTAN
IN
05
300021242
IN
01
P02557637
RAILROAD PTAN
IN
Enumeration date
10/08/2018
Last updated
12/07/2023
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