Provider Demographics
NPI:1366593972
Name:HANSON, PRISCILLA (NP)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 N 44TH ST
Mailing Address - Street 2:#400
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7624
Mailing Address - Country:US
Mailing Address - Phone:602-685-3846
Mailing Address - Fax:602-685-3808
Practice Address - Street 1:444 N 44TH ST
Practice Address - Street 2:#400
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-7624
Practice Address - Country:US
Practice Address - Phone:602-685-3846
Practice Address - Fax:602-685-3808
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN034276364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ489460Medicaid
AZ489460Medicaid
AZ102664Medicare ID - Type Unspecified