Provider Demographics
NPI:1194873661
Name:HANSON, CHARLENE MARIE (RN, FNP)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MARIE
Last Name:HANSON
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 ENGLISHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31711-3406
Mailing Address - Country:US
Mailing Address - Phone:478-472-6792
Mailing Address - Fax:478-472-1222
Practice Address - Street 1:FLINT RIVER HOSPITAL, 509 SUMPTER STREET
Practice Address - Street 2:
Practice Address - City:MONTEZUMA
Practice Address - State:GA
Practice Address - Zip Code:31063
Practice Address - Country:US
Practice Address - Phone:478-472-8178
Practice Address - Fax:478-472-3289
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN056471 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily