Provider Demographics
NPI:1437299831
Name:HANSEN, MARY PAT (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY PAT
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:PATRICIA
Other - Last Name:COSGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:1114 W MAIN ST
Mailing Address - Street 2:SOUTH VALLEY PEDIATRICS
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840
Mailing Address - Country:US
Mailing Address - Phone:406-363-5013
Mailing Address - Fax:406-363-3714
Practice Address - Street 1:1114 W MAIN ST
Practice Address - Street 2:SOUTH VALLEY PEDIATRICS
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840
Practice Address - Country:US
Practice Address - Phone:406-363-5013
Practice Address - Fax:406-363-3714
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN 31255363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics