Provider Demographics
NPI:1720277601
Name:HACKMAN, DONNA (NP-C)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:HACKMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:IN
Mailing Address - Zip Code:46701-1251
Mailing Address - Country:US
Mailing Address - Phone:260-636-7938
Mailing Address - Fax:260-636-1049
Practice Address - Street 1:209 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IN
Practice Address - Zip Code:46701-1251
Practice Address - Country:US
Practice Address - Phone:260-636-7938
Practice Address - Fax:260-636-1049
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002502A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000549136OtherANTHEM
IN000000548973OtherANTHEM
INP00478527OtherRAILROAD MEDICARE
IN000000528690OtherANTHEM
IN200879960Medicaid
IN200879960Medicaid
IN250260DMedicare PIN