Provider Demographics
NPI:1972339166
Name:HANSON, CASSIDY JAE (PA-C)
Entity type:Individual
Prefix:MS
First Name:CASSIDY
Middle Name:JAE
Last Name:HANSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 COUNTY ROAD HQ
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-8855
Mailing Address - Country:US
Mailing Address - Phone:906-273-0072
Mailing Address - Fax:
Practice Address - Street 1:4289 E MAPLE RIDGE 37TH RD
Practice Address - Street 2:
Practice Address - City:ROCK
Practice Address - State:MI
Practice Address - Zip Code:49880-9582
Practice Address - Country:US
Practice Address - Phone:906-420-4759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601012721363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant