Individual
LIZAROSE Y. T. HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CERTIFIED FAMILY HOM
Contact information
Practice address
5201 MESQUITE DR APT 3, CHUBBUCK, ID 83202-5135
(208) 705-0591
Mailing address
5201 MESQUITE DR APT 3, CHUBBUCK, ID 83202-5135
(208) 705-0591
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
CFH-6547
ID
Other
Enumeration date
03/15/2023
Last updated
03/15/2023
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