Provider Demographics
NPI:1629224654
Name:HANSON, TAMMY MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:MARIE
Last Name:HANSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FARM LN
Mailing Address - Street 2:APT 2B
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1935
Mailing Address - Country:US
Mailing Address - Phone:845-464-5376
Mailing Address - Fax:845-473-6692
Practice Address - Street 1:14 FARM LN
Practice Address - Street 2:APT 2B
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1935
Practice Address - Country:US
Practice Address - Phone:845-464-5376
Practice Address - Fax:845-473-6692
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282791-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse