Hansen, Mulloy G
Hansen, Mulloy G is an sole proprietor health care provider with primary practice located at 338 6Th St Ste 101 , Lewiston ID 83501-2419. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Hansen, Mulloy G can be contacted via phone (120) 884-8830.Contact Information
Primary practice address
338 6Th St Ste 101
Lewiston ID 83501-2419
Phone: (120) 884-8830
Fax: (509) 444-7806
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | MD00015580 | Washington |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | M-10654 | Idaho |
Profile Details
| NPI number | 1538358635 |
|---|---|
| LBN Legal business name | Hansen, Mulloy G |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 15th, 2007 |
| Last updated | Jun 29th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1538358635 | NPPES |
| Washington | MEDICAID | 7081771 |
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