Provider Demographics
NPI:1164762407
Name:HANSON, ROBIN M (STNA)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:M
Last Name:HANSON
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 34TH ST SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-5028
Mailing Address - Country:US
Mailing Address - Phone:330-206-0817
Mailing Address - Fax:
Practice Address - Street 1:322 34TH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-5028
Practice Address - Country:US
Practice Address - Phone:330-206-0817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-24
Last Update Date:2013-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400795690808376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide