Provider Demographics
NPI:1518262385
Name:HANSEN, CARL DONALD JR (LPN)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:DONALD
Last Name:HANSEN
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 STATE ROUTE 48
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8481
Mailing Address - Country:US
Mailing Address - Phone:937-903-2343
Mailing Address - Fax:
Practice Address - Street 1:6707 STATE ROUTE 48
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-8481
Practice Address - Country:US
Practice Address - Phone:937-903-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 120166164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse