Individual
COLLEEN FAYE HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
120 N C AVE, THERMOPOLIS, WY 82443-2410
(307) 864-5534
(307) 864-9470
Mailing address
120 N C AVE, THERMOPOLIS, WY 82443-2410
(307) 864-5534
(307) 864-9470
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
170
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1112CH98M
WY CONTROLLED SUBSTANCE #
WY
01
—
170
WY MEDICAL LICENSE #
WY
Enumeration date
02/01/2006
Last updated
03/07/2023
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