Provider Demographics
NPI:1477146595
Name:HANSON, TRUDY LYNN (AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:LYNN
Last Name:HANSON
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:225 SMITH AVE N
Practice Address - Street 2:SUITE 300
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2592
Practice Address - Country:US
Practice Address - Phone:651-241-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR424772083X0100X, 363LG0600X
MN7705363LX0106X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health