Provider Demographics
NPI:1245237809
Name:HANSON, NICOLE ANDREA (APRN, BC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANDREA
Last Name:HANSON
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 26TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5161
Mailing Address - Country:US
Mailing Address - Phone:406-731-8888
Mailing Address - Fax:
Practice Address - Street 1:1101 26TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5161
Practice Address - Country:US
Practice Address - Phone:406-731-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT101488363L00000X
MNR1441354363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN255496800Medicaid
SDENROLLEDMedicaid
IAENROLLEDMedicaid
WIENROLLEDMedicaid
MNENROLLEDMedicaid
MNP01089516OtherRAILROAD MEDICARE
MN255496800Medicaid
WIENROLLEDMedicaid
MN500006190Medicare PIN