Provider Demographics
NPI:1528075272
Name:HANSON, GWEN S (MD PLLC)
Entity type:Individual
Prefix:DR
First Name:GWEN
Middle Name:S
Last Name:HANSON
Suffix:
Gender:F
Credentials:MD PLLC
Other - Prefix:DR
Other - First Name:GWEN
Other - Middle Name:SHARYL
Other - Last Name:SZWARC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1409 140TH PL NE
Mailing Address - Street 2:SUITE #106
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007
Mailing Address - Country:US
Mailing Address - Phone:425-614-1205
Mailing Address - Fax:425-641-5796
Practice Address - Street 1:1409 140TH PL NE
Practice Address - Street 2:SUITE #106
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007
Practice Address - Country:US
Practice Address - Phone:425-614-1205
Practice Address - Fax:425-641-5796
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F77755Medicare UPIN