Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2015031754 | MO |
NPI | 1013203553 |
---|---|
Provider Name | Jessica Anne Hanson |
First Address | Springfield, MO 65808-9007 |
Second Address | Springfield, MO 65807-7310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2011 |
Last Update Date | 27/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013203553 | (05) | MO |
200025615 | (05) | MO |