1578588539 NPI number — DR. SHIRLEY MAY HANSON PMHNP, PHD

Table of content: DR. SHIRLEY MAY HANSON PMHNP, PHD (NPI 1578588539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578588539 NPI number — DR. SHIRLEY MAY HANSON PMHNP, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSON
Provider First Name:
SHIRLEY
Provider Middle Name:
MAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578588539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8325 SW CARMEL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97223-6951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-245-8099
Provider Business Mailing Address Fax Number:
503-452-8571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7912 SW 35TH AVE
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97219-2427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-452-8571
Provider Business Practice Location Address Fax Number:
503-452-8571
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X , with the licence number:  084051100N6 PMHNP-PP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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