Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 35068533 | OH |
N | 207V00000X | Obstetrician & Gynecologist | 4301057977 | MI |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 01053849A | IN |
NPI | 1578600565 |
---|---|
Provider Name | Craig E Hanson |
First Address | Hicksville, OH 43526-1250 |
Second Address | Hicksville, OH 43526-1250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 18/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0161720 | (05) | OH |
200841050 | (05) | IN |