Provider Demographics
NPI:1508279472
Name:HANSEN, JENNIFER NICOLE SHERRY (DNP, CNM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE SHERRY
Last Name:HANSEN
Suffix:
Gender:F
Credentials:DNP, CNM
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:SHERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, CNM
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:PO BOX 1309 MAIL STOP 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6500 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4702
Practice Address - Country:US
Practice Address - Phone:952-993-3282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-08
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNM1590367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400222261Medicare PIN