Provider Demographics
NPI:1972628444
Name:HANSON, DWAYNE N (MBA)
Entity Type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:N
Last Name:HANSON
Suffix:
Gender:M
Credentials:MBA
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 113273
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-3273
Mailing Address - Country:US
Mailing Address - Phone:907-332-5283
Mailing Address - Fax:907-332-5283
Practice Address - Street 1:15921 NOBLE POINT DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-7548
Practice Address - Country:US
Practice Address - Phone:907-332-5283
Practice Address - Fax:907-332-5283
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM4321Medicaid