Provider Demographics
NPI:1609610195
Name:HANSON, CAROL
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:HANSON
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 1:103 5TH AVE E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:ND
Mailing Address - Zip Code:58727-7015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 5TH AVE E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:ND
Practice Address - Zip Code:58727-7015
Practice Address - Country:US
Practice Address - Phone:818-795-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant