Provider Demographics
NPI:1306199799
Name:HANSON, KORPO NGAIMA (NP)
Entity Type:Individual
Prefix:
First Name:KORPO
Middle Name:NGAIMA
Last Name:HANSON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:952-883-6117
Practice Address - Street 1:2220 RIVERSIDE AVE
Practice Address - Street 2:MC 21110Q HEALTHPARTNERS RIVERSIDE CLINIC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1321
Practice Address - Country:US
Practice Address - Phone:952-883-6805
Practice Address - Fax:952-883-6117
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2013-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNA0712171363LA2200X
MNG0812010363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health