Provider Demographics
NPI:1336408335
Name:HANSEN, MELINDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:M
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 DIPLOMACY DRIVE
Mailing Address - Street 2:SOUTHCENTRAL FOUNDATION
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4501 DIPLOMACY DRIVE
Practice Address - Street 2:SOUTHCENTRAL FOUNDATION
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-0000
Practice Address - Country:US
Practice Address - Phone:907-729-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1110372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry