Provider Demographics
NPI:1194039495
Name:HANSEN, MARSHALL PETER (MD)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:PETER
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 6TH ST E
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2501
Mailing Address - Country:US
Mailing Address - Phone:507-403-1048
Mailing Address - Fax:952-516-5300
Practice Address - Street 1:2980 130TH ST E
Practice Address - Street 2:LITTLE PRAIRIE UNITED METHODIST CHURCH/HEALTHFINDERS
Practice Address - City:DUNDAS
Practice Address - State:MN
Practice Address - Zip Code:55019-4231
Practice Address - Country:US
Practice Address - Phone:507-646-8964
Practice Address - Fax:952-516-5300
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43514207Q00000X
SC13860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine