Provider Demographics
NPI:1922202365
Name:CARNEY-HANSON, CHARA MARIE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:CHARA
Middle Name:MARIE
Last Name:CARNEY-HANSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 E ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-2315
Mailing Address - Country:US
Mailing Address - Phone:360-755-1919
Mailing Address - Fax:
Practice Address - Street 1:2108 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5406
Practice Address - Country:US
Practice Address - Phone:360-428-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019123225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist