Provider Demographics
NPI:1104178979
Name:HANSON, VALERIE ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:ANN
Last Name:HANSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 20TH AVE S
Mailing Address - Street 2:APT 15
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4767
Mailing Address - Country:US
Mailing Address - Phone:701-306-5071
Mailing Address - Fax:
Practice Address - Street 1:4510 19TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-0802
Practice Address - Country:US
Practice Address - Phone:701-306-5071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND620172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist