1770112153 NPI number — CHRISTINA NOELLE HANSON PHARMD

Table of content: CHRISTINA NOELLE HANSON PHARMD (NPI 1770112153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770112153 NPI number — CHRISTINA NOELLE HANSON PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSON
Provider First Name:
CHRISTINA
Provider Middle Name:
NOELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORRISON
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
NOELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770112153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1715 RYAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50801-8352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-261-7195
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
406 S HAYES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT AYR
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50854-1916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-464-3300
Provider Business Practice Location Address Fax Number:
641-464-3303
Provider Enumeration Date:
04/07/2020

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: 183500000X , with the licence number:  15798 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 23498 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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