Provider Demographics
NPI:1043797566
Name:HANLON, SCOTT
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:HANLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 HEYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2982
Mailing Address - Country:US
Mailing Address - Phone:507-301-4222
Mailing Address - Fax:
Practice Address - Street 1:12980 DENNISON BLVD S
Practice Address - Street 2:
Practice Address - City:DENNISON
Practice Address - State:MN
Practice Address - Zip Code:55018-4113
Practice Address - Country:US
Practice Address - Phone:507-301-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty