Provider Demographics
NPI:1093810376
Name:HANSON, JEAN E (PA)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:E
Last Name:HANSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0304
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:325 MAIN ST
Practice Address - Street 2:HUDSON FALLS INTERNAL MEDICINE
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-1512
Practice Address - Country:US
Practice Address - Phone:518-926-5924
Practice Address - Fax:518-926-6983
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA091363A00000X
NY003082363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME295560099Medicaid
AP1661Medicare PIN