Provider Demographics
NPI:1215463468
Name:HANSON, BERNADETTE
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
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 1:101 NUNAM IQUA AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:NUNAM
Mailing Address - State:AK
Mailing Address - Zip Code:99666
Mailing Address - Country:US
Mailing Address - Phone:907-498-4184
Mailing Address - Fax:907-498-4182
Practice Address - Street 1:101 NUNAM IQUA AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:NUNAM
Practice Address - State:AK
Practice Address - Zip Code:99666
Practice Address - Country:US
Practice Address - Phone:907-498-4184
Practice Address - Fax:907-498-4182
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker