Basic Information
| Provider Information | |||||||||
| NPI: | 1770878134 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANSEL | ||||||||
| FirstName: | MARLA | ||||||||
| MiddleName: | RENE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 186 PROVIDENCE ST | ||||||||
| Address2: | THUNDERMIST HEALTH CENTER | ||||||||
| City: | WEST WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028932508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016152800 | ||||||||
| FaxNumber: | 4013564709 | ||||||||
| Practice Location | |||||||||
| Address1: | 186 PROVIDENCE ST | ||||||||
| Address2: | THUNDERMIST HEALTH CENTER | ||||||||
| City: | WEST WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028932508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016152800 | ||||||||
| FaxNumber: | 4013564709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2011 | ||||||||
| LastUpdateDate: | 06/19/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD14602 | RI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.