=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043885429
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARINA GERALDINE HANSEN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2021
-----------------------------------------------------
Last Update Date | 08/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 123 S 27TH ST
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59101-4227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-247-3350
-----------------------------------------------------
Fax | 406-247-3389
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 12
-----------------------------------------------------
City | LIBERTY LAKE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99019-0012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-747-2455
-----------------------------------------------------
Fax | 406-327-3231
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MED-PHYS-LIC-143283
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------