Provider Demographics
NPI:1518668805
Name:MICHAEL HANSON, LLC
Entity Type:Organization
Organization Name:MICHAEL HANSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-309-3017
Mailing Address - Street 1:1205 CASSEL RUN RD
Mailing Address - Street 2:
Mailing Address - City:BLUE CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45616-9759
Mailing Address - Country:US
Mailing Address - Phone:937-309-3017
Mailing Address - Fax:833-743-5214
Practice Address - Street 1:1325 E KEMPER RD STE 200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3946
Practice Address - Country:US
Practice Address - Phone:937-217-9330
Practice Address - Fax:513-718-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty