Individual
BEVERLY HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 782-3993
(208) 782-3994
Mailing address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 782-3993
(208) 782-3994
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PAG-012
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010154328
REGENCE BLUE SHIELD
ID
01
—
000010167603
RBS LAMERE
ID
05
—
807338600
—
ID
01
—
HB405
BLUE CROSS
ID
01
—
HPAC6
BLUE CROSS OLD
ID
01
—
PAJ80
BCS LAMERE
ID
Enumeration date
05/03/2006
Last updated
09/09/2008
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