Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | ||
Y | 176B00000X | Midwife | 795 | NC |
NPI | 1134795859 |
---|---|
Provider Name | Patricia Ippolito Hanson |
First Address | Cape Carteret, NC 28584-0015 |
Second Address | Jacksonville, NC 28546-6333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2021 |
Last Update Date | 02/06/2021 |