Provider Demographics
NPI:1396987723
Name:HANSON, MARIT (LAC)
Entity type:Individual
Prefix:
First Name:MARIT
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 E WOODIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-9648
Mailing Address - Country:US
Mailing Address - Phone:425-359-4739
Mailing Address - Fax:
Practice Address - Street 1:414 E WOODIN AVE
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-9648
Practice Address - Country:US
Practice Address - Phone:425-359-4739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002992171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist