Provider Demographics
NPI:1962195016
Name:HANSEN, BLAKE (DNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 S 250 W
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-9620
Mailing Address - Country:US
Mailing Address - Phone:317-797-2012
Mailing Address - Fax:
Practice Address - Street 1:1200 ROOSEVELT PL STE 102
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3707
Practice Address - Country:US
Practice Address - Phone:574-282-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013978A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily