Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 10754 | MD |
NPI | 1003816661 |
---|---|
Provider Name | Mrs. Karen E Hansen |
First Address | Olney, MD 20832-1020 |
Second Address | Olney, MD 20832-1020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 28/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6999565 | (05) | MD |
F490-001 | BC/BS (01) | MD |