Provider Demographics
NPI:1396004487
Name:HANSON, VERNON L (RN, NP-C)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:L
Last Name:HANSON
Suffix:
Gender:M
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18103 DANE DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347
Mailing Address - Country:US
Mailing Address - Phone:952-949-1035
Mailing Address - Fax:
Practice Address - Street 1:13688 ROGERS DR
Practice Address - Street 2:SUITE 230
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4916
Practice Address - Country:US
Practice Address - Phone:952-949-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 183741-8363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily