Provider Demographics
NPI:1336285279
Name:HANSON, DIANNE CAROL (NP)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:CAROL
Last Name:HANSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2825
Mailing Address - Country:US
Mailing Address - Phone:516-659-2620
Mailing Address - Fax:855-839-6113
Practice Address - Street 1:17 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2825
Practice Address - Country:US
Practice Address - Phone:516-659-2620
Practice Address - Fax:855-839-6113
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303830363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0512G1Medicare ID - Type UnspecifiedNASSAU
NY06214AMedicare ID - Type UnspecifiedQUEENS