Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 68732-20 | WI |
N | 207YP0228X | Pediatric Otolaryngology | 43553 | MA |
NPI | 1831180934 |
---|---|
Provider Name | Dr. Maynard C. Hansen |
First Address | Chippewa Falls, WI 54729-5407 |
Second Address | Chippewa Falls, WI 54729-5407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 15/10/2018 |