Healthcare Provider Details

I. General information

NPI: 1083080295
Provider Name (Legal Business Name): HANNAH LEE MANSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH L BAER PA

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SENTARA CIR RM 2C
WILLIAMSBURG VA
23188-5713
US

IV. Provider business mailing address

100 SENTARA CIR RM 2C
WILLIAMSBURG VA
23188-5713
US

V. Phone/Fax

Practice location:
  • Phone: 757-984-7217
  • Fax: 757-984-7210
Mailing address:
  • Phone: 757-984-7217
  • Fax: 757-984-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2537
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110007149
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: