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Individual
MANDY O HANSEN
Active
Individual
MANDY O HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA05742
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203346601
—
TX
01
—
8Y8556
BCBS
TX
01
—
P00626753
RR MEDICARE
TX
Enumeration date
03/27/2008
Last updated
12/19/2011
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