MEDICARE: SHANNON GABRIELLE HANSEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	51866	MN
2	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	MD60293423	WA
3	207Q00000X	Family Medicine Physician	MD60293423	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00767187	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	01-37427	OTHER		MEDICA

General Provider Information

NPI Number	:	1417124538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON GABRIELLE HANSEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 34703
Second Line	:	MS: 820-5-PCO
City	:	SEATTLE
State	:	WA
Zip	:	98124-1703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3622 ENSIGN RD NE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5081
Country	:	US
Telephone Number	:	360-742-5000
Fax Number	:	360-742-5019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	04/22/2026

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Directions to “ SHANNON GABRIELLE HANSEN M.D.” Practice Location

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