Provider Demographics
NPI:1629414578
Name:HANSEN, HEIDI ANN (APRN, CNP)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ANN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 E GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:IVANHOE
Mailing Address - State:MN
Mailing Address - Zip Code:56142-9711
Mailing Address - Country:US
Mailing Address - Phone:507-694-1377
Mailing Address - Fax:507-694-1379
Practice Address - Street 1:366 E GEORGE ST
Practice Address - Street 2:
Practice Address - City:IVANHOE
Practice Address - State:MN
Practice Address - Zip Code:56142-9711
Practice Address - Country:US
Practice Address - Phone:507-694-1377
Practice Address - Fax:507-694-1379
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR180645-2163W00000X
MN3686363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse