Provider Demographics
NPI:1023521234
Name:HANSEN, MARY PAULETTE (APRN-CNS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:PAULETTE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:APRN-CNS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:PAULETTE
Other - Last Name:NEWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12406 SW 55TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7113
Mailing Address - Country:US
Mailing Address - Phone:253-229-7391
Mailing Address - Fax:
Practice Address - Street 1:12406 SW 55TH PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-7113
Practice Address - Country:US
Practice Address - Phone:253-229-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201402489CNS364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine