Provider Demographics
NPI:1376865675
Name:HANSON, BRIDGETTE MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:MARIE
Last Name:HANSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-3511
Mailing Address - Country:US
Mailing Address - Phone:262-567-0160
Mailing Address - Fax:
Practice Address - Street 1:154 S ELM ST
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3511
Practice Address - Country:US
Practice Address - Phone:262-567-0160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-28
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI144163-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health