Provider Demographics
NPI:1841412004
Name:HANSON, DEBRA R (LMP)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:R
Last Name:HANSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S.W. SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2201
Mailing Address - Country:US
Mailing Address - Phone:206-459-0141
Mailing Address - Fax:206-772-2073
Practice Address - Street 1:620 S.W. SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2201
Practice Address - Country:US
Practice Address - Phone:206-459-0141
Practice Address - Fax:206-772-2073
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA09316225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist