Provider Demographics
NPI:1245221266
Name:HANSON, GARY MORRIS (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:MORRIS
Last Name:HANSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 102ND ST NE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-3202
Mailing Address - Country:US
Mailing Address - Phone:763-878-2388
Mailing Address - Fax:763-878-3222
Practice Address - Street 1:291 102ND ST NE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-3202
Practice Address - Country:US
Practice Address - Phone:763-878-2388
Practice Address - Fax:763-878-3222
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 059568-3367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered