Doctor Name: | MARY HANSEN |
NPI Number: | 1023407251 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 5007238 |
Business Practice Address: | 138 Sherlock Dr Statesville, NC - 286251916 |
Business Phone Number: | 7048731021 |
Business Fax Number: | 7048380706 |
Mailing Address: | Po Box 1845, STATESVILLE |
State: | NC |
Postal Code: | 286871845 |
Phone Number: | 7048731021 |
Fax Number: | 7048380706 |
NPI Enumeration Date: | 01/12/2015 |
NPI Last Update Date: | 01/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 5007238 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |