Provider Demographics
NPI:1568690063
Name:HANSON, LORI LYNNETTE (LPN)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:LYNNETTE
Last Name:HANSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 TORNEY AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-6628
Mailing Address - Country:US
Mailing Address - Phone:715-845-7011
Mailing Address - Fax:
Practice Address - Street 1:1328 TORNEY AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6628
Practice Address - Country:US
Practice Address - Phone:715-845-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32540164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse