Healthcare Provider Details

I. General information

NPI: 1174115448
Provider Name (Legal Business Name): RACHEL HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 CENTRAL AVE S
MOHALL ND
58761-4066
US

IV. Provider business mailing address

PO BOX 820
MOHALL ND
58761-0820
US

V. Phone/Fax

Practice location:
  • Phone: 701-721-2266
  • Fax:
Mailing address:
  • Phone: 701-389-8199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: