Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 6259535-9921 | UT |
Y | 213EG0000X | General Practice | 6259535-9921 | UT |
NPI | 1003903386 |
---|---|
Provider Name | Dr. Heather Hansen |
First Address | North Ogden, UT 84414-7210 |
Second Address | North Ogden, UT 84414-7210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 08/07/2007 |