Provider Demographics
NPI:1114591658
Name:HANSON, ANGELA (PA-S2)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:PA-S2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 PIERCE ST APT 1316
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1274
Mailing Address - Country:US
Mailing Address - Phone:530-304-6129
Mailing Address - Fax:
Practice Address - Street 1:199 PIERCE ST APT 1316
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1274
Practice Address - Country:US
Practice Address - Phone:530-304-6129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program