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General NPI Number Information
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NPI Number | 1164823977
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Entity Type | Individual
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Provider Name | BONNIE MCMANAMON HANSON
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Gender | Female
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 4228 HOUMA BLVD STE 130
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City | METAIRIE
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State | LA
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Zip | 70006-3003
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Country | US
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Telephone | 504-454-2222
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Fax | 504-454-2388
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Provider Business Mailing Address
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Address Line | 4200 HOUMA BLVD MEDICAL STAFF SERVICES
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City | METAIRIE
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State | LA
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Zip | 70006-2429
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Country | US
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Telephone | 504-503-6781
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Fax | 504-503-5667
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.200729
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License Number State | LA
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