Provider Demographics
NPI:1245520642
Name:HANSON, MARY FAYE
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:FAYE
Last Name:HANSON
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 1:722 E CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4015
Mailing Address - Country:US
Mailing Address - Phone:817-507-9315
Mailing Address - Fax:214-666-8482
Practice Address - Street 1:722 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4015
Practice Address - Country:US
Practice Address - Phone:817-507-9315
Practice Address - Fax:214-666-8482
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201000215992171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications