Provider Demographics
NPI:1689670747
Name:HANSEN, ANNA M (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:M
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:359-355-3419
Practice Address - Street 1:619 5TH STREET
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:IA
Practice Address - Zip Code:52747
Practice Address - Country:US
Practice Address - Phone:563-785-4487
Practice Address - Fax:563-785-6681
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001239363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
4796890001OtherDMERC
150016OtherIOWA HEALTH SOLUTIONS
IA0173OtherJOHN DEERE HEALTH PLAN
077614OtherHEALTH ALLIANCE
4796890001OtherDMERC
IA0173OtherJOHN DEERE HEALTH PLAN