Provider Demographics
NPI:1346364312
Name:CHAVEZ-HANSEN, RIANNE ISABEL (LMT, LMP)
Entity Type:Individual
Prefix:MS
First Name:RIANNE
Middle Name:ISABEL
Last Name:CHAVEZ-HANSEN
Suffix:
Gender:F
Credentials:LMT, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 NORTHSIDE DR UNIT 402
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3687
Mailing Address - Country:US
Mailing Address - Phone:850-867-3795
Mailing Address - Fax:850-215-8398
Practice Address - Street 1:2101 NORTHSIDE DR UNIT 402
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3687
Practice Address - Country:US
Practice Address - Phone:850-867-3795
Practice Address - Fax:850-215-8398
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48125174400000X
WAMA20039174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist