Provider Demographics
NPI:1134129653
Name:HANSON, CHRISTENA (RPAC)
Entity Type:Individual
Prefix:
First Name:CHRISTENA
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:67439-0103
Mailing Address - Country:US
Mailing Address - Phone:785-472-3111
Mailing Address - Fax:785-472-5731
Practice Address - Street 1:1602 N AYLWARD AVE
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:KS
Practice Address - Zip Code:67439-2541
Practice Address - Country:US
Practice Address - Phone:785-472-3111
Practice Address - Fax:785-472-5731
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500341363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS654661OtherFIRST GUARD
KS100354460DMedicaid
KS042679OtherBCBS
KS654661OtherFIRST GUARD
KS042679OtherBCBS