Provider Demographics
NPI:1558558916
Name:HANSEN, PATRICIA MACLONE (RN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MACLONE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:MACLONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:22 TOURO AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-7124
Mailing Address - Country:US
Mailing Address - Phone:781-395-4786
Mailing Address - Fax:
Practice Address - Street 1:22 TOURO AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-7124
Practice Address - Country:US
Practice Address - Phone:781-395-4786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151194163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse