Provider Demographics
NPI:1215163746
Name:HANSON, HAZEL M (APNP)
Entity type:Individual
Prefix:
First Name:HAZEL
Middle Name:M
Last Name:HANSON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 OAK ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3800
Mailing Address - Country:US
Mailing Address - Phone:262-334-8339
Mailing Address - Fax:262-306-7717
Practice Address - Street 1:1201 OAK ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3800
Practice Address - Country:US
Practice Address - Phone:262-334-8339
Practice Address - Fax:262-306-7717
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3286-033363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care