Provider Demographics
NPI:1568465870
Name:HANSOM, JANET GAIL (MD)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:GAIL
Last Name:HANSOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 EAST SECTION STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-9124
Mailing Address - Country:US
Mailing Address - Phone:360-428-1700
Mailing Address - Fax:360-848-4350
Practice Address - Street 1:2116 EAST SECTION STREET
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-9124
Practice Address - Country:US
Practice Address - Phone:360-428-1700
Practice Address - Fax:360-848-4350
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8138372Medicaid
WA8138372Medicaid
F34744Medicare UPIN