Provider Demographics
NPI:1710203195
Name:HANSEN, ANN ELIZABETH (DVM, MD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:ELIZABETH
Last Name:HANSEN
Suffix:
Gender:F
Credentials:DVM, MD
Other - Prefix:DR
Other - First Name:ANN
Other - Middle Name:ELIZABETH
Other - Last Name:KRAUS-HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DVM
Mailing Address - Street 1:500 W FORT ST
Mailing Address - Street 2:MEDICAL SERVICE OFFICE
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4501
Mailing Address - Country:US
Mailing Address - Phone:208-422-1314
Mailing Address - Fax:208-422-1319
Practice Address - Street 1:500 W FORT ST
Practice Address - Street 2:MEDICAL SERVICE OFFICE
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4501
Practice Address - Country:US
Practice Address - Phone:208-422-1314
Practice Address - Fax:208-422-1319
Is Sole Proprietor?:No
Enumeration Date:2010-04-11
Last Update Date:2015-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM11711207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine