Healthcare Provider Details

I. General information

NPI: 1346252376
Provider Name (Legal Business Name): DONNA JEAN HANSON MPAS, PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20905 EASTSIDE DRIVE #1
CHUGIAK AK
99567-1249
US

IV. Provider business mailing address

PO BOX 671249 20905 EASTSIDE DRIVE #1
CHUGIAK AK
99567-1249
US

V. Phone/Fax

Practice location:
  • Phone: 907-688-0901
  • Fax: 907-688-0830
Mailing address:
  • Phone: 907-688-0901
  • Fax: 907-688-0830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number406
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: