Provider Demographics
NPI:1467830976
Name:HANSON, DANIELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:GOODRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:715-838-5222
Mailing Address - Fax:
Practice Address - Street 1:1400 BELLINGER ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703
Practice Address - Country:US
Practice Address - Phone:715-838-3635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-16
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3575363A00000X
WI363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical