Healthcare Provider Details

I. General information

NPI: 1376597021
Provider Name (Legal Business Name): LISBET M HANSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 FIRST COLONIAL RD STE 200
VA BEACH VA
23454
US

IV. Provider business mailing address

1181 FIRST COLONIAL RD STE 200
VA BEACH VA
23454
US

V. Phone/Fax

Practice location:
  • Phone: 757-425-1600
  • Fax: 757-425-6495
Mailing address:
  • Phone: 757-425-1600
  • Fax: 757-425-6495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101039398
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: