Provider Demographics
NPI:1508341157
Name:HANSON, TODD DAVID (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:DAVID
Last Name:HANSON
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 89TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55444-1233
Mailing Address - Country:US
Mailing Address - Phone:612-615-3997
Mailing Address - Fax:
Practice Address - Street 1:1601 89TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55444-1233
Practice Address - Country:US
Practice Address - Phone:612-615-3997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-29
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1207048163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse