Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 036-054233 | IL |
Y | 207RC0200X | Critical Care Medicine | R2C19 | MO |
NPI | 1013909589 |
---|---|
Provider Name | Lesley Ann Hanson |
First Address | Saint Louis, MO 63141-5047 |
Second Address | Saint Louis, MO 63136-6119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 10/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013909589 | (05) | MO |
E42772 | (02) | MO |