Provider Demographics
NPI:1841508009
Name:HANSON, BRIANNA RIDER (PA-C)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:RIDER
Last Name:HANSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11790 SW BARNES RD STE 330
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5935
Mailing Address - Country:US
Mailing Address - Phone:503-228-4414
Mailing Address - Fax:
Practice Address - Street 1:11790 SW BARNES RD STE 330
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5935
Practice Address - Country:US
Practice Address - Phone:503-228-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant