1972628444 NPI number — MR. DWAYNE N HANSON MBA

Table of content: MR. DWAYNE N HANSON MBA (NPI 1972628444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972628444 NPI number — MR. DWAYNE N HANSON MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSON
Provider First Name:
DWAYNE
Provider Middle Name:
N
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MBA
Provider Gender Code:
M

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:
1972628444
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:
PO BOX 113273
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99511-3273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-332-5283
Provider Business Mailing Address Fax Number:
907-332-5283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15921 NOBLE POINT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99516-7548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-332-5283
Provider Business Practice Location Address Fax Number:
907-332-5283
Provider Enumeration Date:
03/21/2007

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CM4321 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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