Healthcare Provider Details

I. General information

NPI: 1861207250
Provider Name (Legal Business Name): MADISYN MARIE HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S 3RD AVE W
MARSING ID
83639-5154
US

IV. Provider business mailing address

212 S 3RD AVE W
MARSING ID
83639-5154
US

V. Phone/Fax

Practice location:
  • Phone: 253-375-3297
  • Fax:
Mailing address:
  • Phone: 253-375-3297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: