Provider Demographics
NPI:1598115263
Name:HANSEN, MARY X (CARE GIVER)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:HANSEN
Suffix:X
Gender:F
Credentials:CARE GIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 226
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAY
Mailing Address - State:TX
Mailing Address - Zip Code:76366-0226
Mailing Address - Country:US
Mailing Address - Phone:940-583-4519
Mailing Address - Fax:
Practice Address - Street 1:200 SOUTH BOIS D ARC
Practice Address - Street 2:
Practice Address - City:HOLLIDAY
Practice Address - State:TX
Practice Address - Zip Code:76366-0226
Practice Address - Country:US
Practice Address - Phone:940-583-4519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant