Healthcare Provider Details

I. General information

NPI: 1114149762
Provider Name (Legal Business Name): JANA MARIE HANSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 HAMLINE ST
GRAND FORKS ND
58203-2819
US

IV. Provider business mailing address

725 HAMLINE ST
GRAND FORKS ND
58203-2819
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-6870
  • Fax: 701-780-6878
Mailing address:
  • Phone: 701-780-6870
  • Fax: 701-780-6878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number4229
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: