Healthcare Provider Details

I. General information

NPI: 1275276222
Provider Name (Legal Business Name): RYAN MICHELLE HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL MSC 8208-0016-01
ST. LOUIS MO
63110
US

IV. Provider business mailing address

1 CHILDRENS PL MSC 8208-0016-01
ST. LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-2527
  • Fax: 314-747-8880
Mailing address:
  • Phone: 314-454-2527
  • Fax: 314-747-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2025020525
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: