Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 6119 | MA |
NPI | 1194235911 |
---|---|
Provider Name | Shannon Marie Hanson |
First Address | Boston, MA 02215-3904 |
Second Address | Boston, MA 02215-3904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2017 |
Last Update Date | 06/10/2017 |