Provider Demographics
NPI:1285927376
Name:HANSEN, NATALIE MARIE (RDH)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:MARIE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:NATALIE
Other - Middle Name:MARIE
Other - Last Name:SOARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:69363 LANTZ LN
Mailing Address - Street 2:
Mailing Address - City:COVE
Mailing Address - State:OR
Mailing Address - Zip Code:97824-8208
Mailing Address - Country:US
Mailing Address - Phone:541-805-9561
Mailing Address - Fax:
Practice Address - Street 1:73265 CONFEDERATED WAY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:541-966-9830
Practice Address - Fax:541-278-7572
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5233124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR171037Medicaid