Provider Demographics
NPI:1316093313
Name:HANSON, NICOLE M
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:HANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1118 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1238
Mailing Address - Country:US
Mailing Address - Phone:207-989-9827
Mailing Address - Fax:
Practice Address - Street 1:1118 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1238
Practice Address - Country:US
Practice Address - Phone:207-989-9827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME198990000OtherPROVIDER NUMBER FOR MECMS