Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner | IN |
NPI | 1033398300 |
---|---|
Provider Name | Heath Hansen |
First Address | Palos Heights, IL 60463-1440 |
Second Address | Highland, IN 46322-2502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2007 |
Last Update Date | 23/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01622333 | BLUE CROSS BLUE SHIELD (01) | IL |
01622333 | BLUE CROSS BLUE SHIELD (01) | IN |
7454077 | AETNA (01) | IN |