Individual
MR. TYSON HANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1496 N 1070 E, SHELEY, ID 83274
(208) 521-1837
Mailing address
315 WIND RIVER DR, SHELLEY, ID 83274-2101
(208) 521-1837
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
—
Other
Enumeration date
06/10/2020
Last updated
06/10/2020
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