Individual
JUDI HANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
611 OCEAN AVE, MANZANITA, OR 97130-9060
(503) 368-8637
Mailing address
611 OCEAN AVE, MANZANITA, OR 97130-9060
(503) 368-8637
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
04/25/2017
Last updated
04/25/2017
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