Provider Demographics
NPI:1013488709
Name:HANSEN, BILLIE JO
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:JO
Last Name:HANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S ROBERTS ST STE 400
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8206
Mailing Address - Country:US
Mailing Address - Phone:907-373-3953
Mailing Address - Fax:907-373-3983
Practice Address - Street 1:850 S ROBERTS ST STE 400
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8206
Practice Address - Country:US
Practice Address - Phone:907-373-3953
Practice Address - Fax:907-373-3983
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1624210373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1624210Medicaid