Provider Demographics
NPI:1275779308
Name:HANSON, DANETTE FLORENE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:DANETTE
Middle Name:FLORENE
Last Name:HANSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 DARTMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-2115
Mailing Address - Country:US
Mailing Address - Phone:248-628-1352
Mailing Address - Fax:
Practice Address - Street 1:10350 DARTMOUTH RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-2115
Practice Address - Country:US
Practice Address - Phone:248-628-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4707156459363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008661230OtherBCBS