Provider Demographics
NPI:1568469138
Name:HANSEN, MARLAND ABE (MD)
Entity Type:Individual
Prefix:MR
First Name:MARLAND
Middle Name:ABE
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2068 TALBERT DR
Mailing Address - Street 2:STE 150
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7723
Mailing Address - Country:US
Mailing Address - Phone:530-809-0009
Mailing Address - Fax:530-809-0399
Practice Address - Street 1:812 E D ST
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-9545
Practice Address - Country:US
Practice Address - Phone:559-925-1000
Practice Address - Fax:559-925-1084
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG13797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG137971Medicaid
CAOOG137971Medicaid