Provider Demographics
NPI:1477698736
Name:HANSEN, BETTY JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:JEAN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25944 COMMUNITY PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9721
Mailing Address - Country:US
Mailing Address - Phone:360-854-7070
Mailing Address - Fax:
Practice Address - Street 1:25959 COMMUNITY PLAZA WAY
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-9721
Practice Address - Country:US
Practice Address - Phone:360-854-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00022558164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7084338Medicaid