IndividualActive
Beverly Hanson, PA
NPI 1003874389 · Surgical Physician Assistant · Blackfoot, ID
Provider details
- NPI number
- 1003874389
- Entity type
- Individual
- Primary specialty
- Surgical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA
- Sex
- Female
- Sole proprietor
- No
- License
- PAG-012 (ID)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
98 Poplar St
Blackfoot, ID 83221-1758
Phone: (208) 782-3993
Fax: (208) 782-3994
Approximate (ZIP-level) locationGet directions
Mailing address
98 Poplar St
Blackfoot, ID 83221-1758
Registry dates
- Enumerated
- 2006-05-03
- Last updated
- 2008-09-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.