Provider Demographics
NPI:1225535701
Name:HANSON, KARISSA (CNP)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:660 VANDEBERG ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002-3251
Mailing Address - Country:US
Mailing Address - Phone:156-847-4117
Mailing Address - Fax:
Practice Address - Street 1:660 VANDEBERG ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-3251
Practice Address - Country:US
Practice Address - Phone:156-847-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6039363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner