| NPI | 1811192362 |
|---|---|
| Former Name | MICHELLE A HANSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001772A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085001934) |
| 363AM0700X Physician Assistant, Medical (Licence: IN 10001772A) | |
| 363A00000X Physician Assistant (Licence: IN 10001772B) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2016-10-04 |