Healthcare Provider Details

I. General information

NPI: 1518954874
Provider Name (Legal Business Name): STEPHANIE B. HANSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6902
US

IV. Provider business mailing address

PO BOX 731280
DALLAS TX
75373-1280
US

V. Phone/Fax

Practice location:
  • Phone: 337-261-5151
  • Fax:
Mailing address:
  • Phone: 318-841-9532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number020858
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: