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Beverly Hanson, PA
Surgical Physician Assistant in Blackfoot, Idaho
NPI 1003874389

Beverly Hanson is a Surgical Physician Assistant based in Blackfoot, ID and is specialized in Surgical. Beverly Hanson practices in Blackfoot, ID and has the professional credentials of PA. The NPI Number for Beverly Hanson is 1003874389 and holds a License No. PAG-012 (Idaho).

The current practice location address for Beverly Hanson is 98 Poplar St, Blackfoot, ID and can be reached out via phone at 208-782-3993 and via fax at 208-782-3994.

Location: 98 Poplar St, Blackfoot, ID, 83221-1758
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Provider Profile Details
NPI Number
1003874389
Provider Name
Beverly Hanson
Credential
PA
Provider Entity Type
Individual
Gender
Female
Address
98 Poplar St, Blackfoot, ID, 83221-1758
Phone Number
208-782-3993
Fax Number
208-782-3994
Provider Enumeration Date
05/03/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
000010167603 01 ID RBS LAMERE
HPAC6 01 ID BLUE CROSS OLD
PAJ80 01 ID BCS LAMERE
000010154328 01 ID REGENCE BLUE SHIELD
HB405 01 ID BLUE CROSS
807338600 05 ID
institution
Provider Business Practice Location Address Details
Address
98 Poplar St
City
State
Zip
83221-1758
Phone Number
208-782-3993
Fax Number
208-782-3994
person
Provider Business Mailing Address Details
Address
98 Poplar St
City
State
Zip
83221-1758
Phone Number
208-782-3993
Fax Number
208-782-3994
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Surgical
Taxonomy
License No.
PAG-012 (Idaho)
Definition
Definition to come...
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