Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 11705 | MN |
NPI | 1063570505 |
---|---|
Provider Name | Rebecca Ann Hanson |
First Address | Saint Cloud, MN 56301-4121 |
Second Address | Saint Cloud, MN 56301-4121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 08/07/2007 |