Provider Demographics
NPI:1649426677
Name:HACKER, DEMA ANNETTE
Entity type:Individual
Prefix:MRS
First Name:DEMA
Middle Name:ANNETTE
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 1:1323 HOGSKIN RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-8136
Mailing Address - Country:US
Mailing Address - Phone:606-598-6587
Mailing Address - Fax:
Practice Address - Street 1:1323 HOGSKIN RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-8136
Practice Address - Country:US
Practice Address - Phone:606-598-6587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator