Provider Demographics
NPI:1326032483
Name:HANSON, ANNA K (FNP-BC, CNM)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:K
Last Name:HANSON
Suffix:
Gender:F
Credentials:FNP-BC, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4338 W THOMAS RD
Mailing Address - Street 2:SUITE # 117
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-3878
Mailing Address - Country:US
Mailing Address - Phone:602-429-2239
Mailing Address - Fax:602-559-5436
Practice Address - Street 1:4338 W THOMAS RD
Practice Address - Street 2:SUITE # 117
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-3878
Practice Address - Country:US
Practice Address - Phone:602-429-2239
Practice Address - Fax:602-559-5436
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP0693363LF0000X
AZRN036650-AP8139367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS58767Medicare UPIN