Provider Demographics
NPI:1356653752
Name:HANSEN, DIANNE M (RN,C AHN-BC, LMT)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:M
Last Name:HANSEN
Suffix:
Gender:F
Credentials:RN,C AHN-BC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1769 LEXINGTON AVE N
Mailing Address - Street 2:N #236
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6522
Mailing Address - Country:US
Mailing Address - Phone:651-785-8279
Mailing Address - Fax:
Practice Address - Street 1:732 LARPENTEUR AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-6558
Practice Address - Country:US
Practice Address - Phone:651-785-8279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20040004594163WM1400X
MNR110668-6163WN1003X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation