Provider Demographics
NPI:1528615846
Name:HANSON, SANDRA HAGENS
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:HAGENS
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 1:3019 CHARTER OAK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-3009
Mailing Address - Country:US
Mailing Address - Phone:501-225-7438
Mailing Address - Fax:
Practice Address - Street 1:3019 CHARTER OAK DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-3009
Practice Address - Country:US
Practice Address - Phone:501-225-7438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider