Provider Demographics
NPI:1548086242
Name:HANSON, JAMIE A (AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:A
Last Name:HANSON
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:A
Other - Last Name:O'DELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1980 CAPE ST
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:MA
Mailing Address - Zip Code:01238-9114
Mailing Address - Country:US
Mailing Address - Phone:413-770-1240
Mailing Address - Fax:
Practice Address - Street 1:10 MAPLE AVE STE 300
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1993
Practice Address - Country:US
Practice Address - Phone:413-854-9932
Practice Address - Fax:413-854-9931
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN270821363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health