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General NPI Number Information
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NPI Number | 1013909589
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Entity Type | Individual
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Provider Name | LESLEY ANN HANSON D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 11133 DUNN RD
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City | SAINT LOUIS
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State | MO
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Zip | 63136-6119
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Country | US
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Telephone | 314-317-0600
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Fax | 314-317-0606
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Provider Business Mailing Address
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Address Line | 12101 WOODCREST EXECUTIVE DR SUITE 210
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City | SAINT LOUIS
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State | MO
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Zip | 63141-5047
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Country | US
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Telephone | 314-317-0600
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Fax | 314-317-0606
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | R2C19
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 036-054233
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License Number State | IL
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