Basic Information
| Provider Information | |||||||||
| NPI: | 1174242093 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSON | ||||||||
| FirstName: | HALEY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 NORTH STADIUM DR | ||||||||
| Address2: | BROUSSARD CENTER FOR ATHLETIC TRAINING | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2255780681 | ||||||||
| FaxNumber: | 2255783924 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 NORTH STADIUM DR | ||||||||
| Address2: | BROUSSARD CENTER FOR ATHLETIC TRAINING | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2255780681 | ||||||||
| FaxNumber: | 2255783924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2022 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.