Healthcare Provider Details

I. General information

NPI: 1548086242
Provider Name (Legal Business Name): JAMIE A HANSON AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE A O'DELL

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MAPLE AVE STE 300
GREAT BARRINGTON MA
01230-1993
US

IV. Provider business mailing address

1980 CAPE ST
LEE MA
01238-9114
US

V. Phone/Fax

Practice location:
  • Phone: 413-854-9932
  • Fax: 413-854-9931
Mailing address:
  • Phone: 413-770-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN270821
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: