Provider Demographics
NPI:1861027856
Name:FERNANDEZ-HANSEN, EDNA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:MARIE
Last Name:FERNANDEZ-HANSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EDNA
Other - Middle Name:MARIE
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:10944 NW EXPRESSWAY STE A
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8214
Mailing Address - Country:US
Mailing Address - Phone:405-373-3122
Mailing Address - Fax:
Practice Address - Street 1:10944 NW EXPRESSWAY STE A
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8214
Practice Address - Country:US
Practice Address - Phone:405-373-3122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1760OtherSTATE LICENSE