Provider Demographics
NPI:1679349146
Name:HACKER, KAITLYN
Entity type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:
Last Name:HACKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10061 PIGEON ROOST RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-8934
Mailing Address - Country:US
Mailing Address - Phone:937-661-1509
Mailing Address - Fax:
Practice Address - Street 1:10061 PIGEON ROOST RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-8934
Practice Address - Country:US
Practice Address - Phone:937-661-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker