Provider Demographics
NPI:1952326274
Name:HANSON, DEBRA J (CNM)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:HANSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:ECU PHYSICIANS
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:ECU PHYSICIANS OBSTETRICS & GYNECOLOGY
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-744-2350
Practice Address - Fax:252-744-2967
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC254499367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH363610OtherWELLCARE
NC7002243Medicaid
OH000000221238OtherUNISON
OH2155288Medicaid
OH738060OtherBUCKEYE
OH000000509165OtherANTHEM
OH7599170OtherAETNA
OH000000509165OtherANTHEM
OH738060OtherBUCKEYE
OH2155288Medicaid
OHHANM00892Medicare PIN