Provider Demographics
NPI:1417525569
Name:HANSON, CHRISTINE KAY
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KAY
Last Name:HANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 SHELDON DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582-6544
Mailing Address - Country:US
Mailing Address - Phone:574-658-9455
Mailing Address - Fax:
Practice Address - Street 1:2695 SHELDON DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582-6544
Practice Address - Country:US
Practice Address - Phone:574-658-9455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28196845A163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice