Provider Demographics
NPI:1437659471
Name:HANSON, SHAUNELL LYNN
Entity Type:Individual
Prefix:
First Name:SHAUNELL
Middle Name:LYNN
Last Name:HANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 JOY DR
Mailing Address - Street 2:
Mailing Address - City:ORE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75683-2207
Mailing Address - Country:US
Mailing Address - Phone:903-736-8039
Mailing Address - Fax:903-736-8039
Practice Address - Street 1:255 JOY DR
Practice Address - Street 2:
Practice Address - City:ORE CITY
Practice Address - State:TX
Practice Address - Zip Code:75683-2207
Practice Address - Country:US
Practice Address - Phone:903-736-8039
Practice Address - Fax:903-736-8039
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX829068163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse