Provider Demographics
NPI:1013045814
Name:HANSON, MARGUERITE LOUISE (LMP)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:LOUISE
Last Name:HANSON
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:MARGOT
Other - Middle Name:L
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:21706 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8247
Mailing Address - Country:US
Mailing Address - Phone:206-276-3891
Mailing Address - Fax:
Practice Address - Street 1:21706 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8247
Practice Address - Country:US
Practice Address - Phone:206-276-3891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012063171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor