1730264904 NPI number — DENISE M HANSON OD

Table of content: DENISE M HANSON OD (NPI 1730264904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730264904 NPI number — DENISE M HANSON OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSON
Provider First Name:
DENISE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730264904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
810 N BAIRD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERGUS FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56537-1617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-736-5609
Provider Business Mailing Address Fax Number:
218-736-5600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 N BAIRD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERGUS FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56537-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-736-5609
Provider Business Practice Location Address Fax Number:
218-736-5600
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  LD2736000 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 670938900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 282T0HA . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 60535 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1021893 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HAN892736 . This is a "ND VISION SERVICE" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 2201477 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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