Provider Demographics
NPI:1457339236
Name:HANSON, LORI JEAN (CNM)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:HANSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2056
Mailing Address - Country:US
Mailing Address - Phone:319-266-5491
Mailing Address - Fax:319-266-5452
Practice Address - Street 1:1824 W 8TH ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2056
Practice Address - Country:US
Practice Address - Phone:319-266-5491
Practice Address - Fax:319-266-5452
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB-077389176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2419218Medicaid
IA0419218Medicaid
IA1419218Medicaid
IA48063Medicare ID - Type Unspecified
IA1419218Medicaid