Lizarose Y. T. Hansen, CERTIFIED FAMILY HOM

NPI #1104527118 in Chubbuck, Idaho

Provider Information

NPI Number: 1104527118
Entity Type: Individual
Name: Lizarose Y. T. Hansen, CERTIFIED FAMILY HOM
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Credential: CERTIFIED FAMILY HOM
Enumeration Date: Mar 15, 2023
Last Updated: Mar 15, 2023

Practice Location

Address: 5201 MESQUITE DR APT 3
City: Chubbuck
State: Idaho
ZIP Code: 83202-5135
Phone: (208) 705-0591

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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