Provider Demographics
NPI:1447029293
Name:HADDAN, DANA LEA
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:LEA
Last Name:HADDAN
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 1:54 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-1611
Mailing Address - Country:US
Mailing Address - Phone:812-508-4805
Mailing Address - Fax:
Practice Address - Street 1:1501 J ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3847
Practice Address - Country:US
Practice Address - Phone:812-902-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program