Healthcare Provider Details

I. General information

NPI: 1568911832
Provider Name (Legal Business Name): CARL L HANSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 STATE ST SUITE 204
ERIE PA
16507-1450
US

IV. Provider business mailing address

333 STATE ST STE 104
ERIE PA
16507-1463
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-5295
  • Fax: 814-877-5299
Mailing address:
  • Phone: 724-933-0300
  • Fax: 724-933-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA003917
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA058564
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: