Provider Demographics
NPI:1467951244
Name:HANSEN, AMBER ELLEN
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ELLEN
Last Name:HANSEN
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 1:12390 SHERBURNE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-1900
Mailing Address - Country:US
Mailing Address - Phone:320-318-0208
Mailing Address - Fax:
Practice Address - Street 1:12390 SHERBURNE AVE STE 202
Practice Address - Street 2:
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308-1900
Practice Address - Country:US
Practice Address - Phone:320-318-0208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist