Provider Demographics
NPI:1326397498
Name:HANSON, JOHN C (LPN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:HANSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8126 W LAIRD RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-8374
Mailing Address - Country:US
Mailing Address - Phone:608-921-3208
Mailing Address - Fax:
Practice Address - Street 1:8126 W LAIRD RD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-8374
Practice Address - Country:US
Practice Address - Phone:608-921-3208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28545-31164W00000X
IL043.062227164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse