Provider Demographics
NPI:1548709181
Name:HANSON, SAMANTHA JANE (PA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANE
Last Name:HANSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2896
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:
Practice Address - Street 1:400 CAMPUS BLVD STE 220
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6906
Practice Address - Country:US
Practice Address - Phone:540-536-5466
Practice Address - Fax:540-536-5475
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2131363A00000X
VA0110-005681363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant