Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1276 | ND |
NPI | 1114198983 |
---|---|
Provider Name | Erika Lea Hanson |
First Address | Fargo, ND 58102-2613 |
Second Address | Fargo, ND 58102-2613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2008 |
Last Update Date | 19/03/2008 |