Provider Demographics
NPI:1295799377
Name:HANSON, CAROL A (DO)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:HANSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2526 E 71ST ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5538
Mailing Address - Country:US
Mailing Address - Phone:918-492-6611
Mailing Address - Fax:918-492-0107
Practice Address - Street 1:2526 E 71ST ST
Practice Address - Street 2:SUITE H
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5538
Practice Address - Country:US
Practice Address - Phone:918-492-6611
Practice Address - Fax:918-492-0107
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK26182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE20584Medicare UPIN