Provider Demographics
NPI:1710692496
Name:HANSEN, HOPE LANE (LMT)
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:LANE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-1909
Mailing Address - Country:US
Mailing Address - Phone:208-596-0014
Mailing Address - Fax:
Practice Address - Street 1:1033 S 3RD ST
Practice Address - Street 2:
Practice Address - City:SAINT MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-8386
Practice Address - Country:US
Practice Address - Phone:208-596-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-1082225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID92-1734984OtherMASSAGE THERAPIST