Provider Demographics
NPI:1215915004
Name:HANSON, MONICA C (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:C
Last Name:HANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8203
Mailing Address - Country:US
Mailing Address - Phone:515-241-2500
Mailing Address - Fax:515-241-2505
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-241-2500
Practice Address - Fax:515-241-2505
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30062208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0112755Medicaid
IA1112755Medicaid
IA1215915004Medicaid
IA0112755Medicaid
IA1215915004Medicaid