Provider Demographics
NPI:1598055949
Name:HANSON, REBECCA SARA (DO)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SARA
Last Name:HANSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-1936
Mailing Address - Country:US
Mailing Address - Phone:651-226-1022
Mailing Address - Fax:
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:MEDICINE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-2300
Practice Address - Fax:612-904-4358
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58352207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine