Provider Demographics
NPI:1063553311
Name:HANSEN, RIANN ELIZABETH (ATC, LMT)
Entity type:Individual
Prefix:
First Name:RIANN
Middle Name:ELIZABETH
Last Name:HANSEN
Suffix:
Gender:F
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:EXIRA
Mailing Address - State:IA
Mailing Address - Zip Code:50076-1535
Mailing Address - Country:US
Mailing Address - Phone:712-268-2320
Mailing Address - Fax:712-563-2045
Practice Address - Street 1:521 LEROY ST
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:IA
Practice Address - Zip Code:50025-1206
Practice Address - Country:US
Practice Address - Phone:712-563-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer