Provider Demographics
NPI:1346252376
Name:HANSON, DONNA JEAN (MPAS, PAC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:HANSON
Suffix:
Gender:F
Credentials:MPAS, PAC
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 671249
Mailing Address - Street 2:20905 EASTSIDE DRIVE #1
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-1249
Mailing Address - Country:US
Mailing Address - Phone:907-688-0901
Mailing Address - Fax:907-688-0830
Practice Address - Street 1:20905 EASTSIDE DRIVE #1
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-1249
Practice Address - Country:US
Practice Address - Phone:907-688-0901
Practice Address - Fax:907-688-0830
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK406363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD57672Medicaid