Provider Demographics
NPI:1821083346
Name:HANSON, LINDA RAE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:RAE
Last Name:HANSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 CHAPPARAL RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-7923
Mailing Address - Country:US
Mailing Address - Phone:406-443-6066
Mailing Address - Fax:
Practice Address - Street 1:2406 CHAPPARAL RD
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-7923
Practice Address - Country:US
Practice Address - Phone:406-443-6066
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT87363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTR10644Medicare UPIN