Provider Demographics
NPI:1700386448
Name:HANSEN, NICOLE SUSANNE (RN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:SUSANNE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N26W24150 RIVER PARK DR APT H
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-5851
Mailing Address - Country:US
Mailing Address - Phone:262-893-7177
Mailing Address - Fax:
Practice Address - Street 1:N26W24150 RIVER PARK DR APT H
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5851
Practice Address - Country:US
Practice Address - Phone:262-893-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI178368163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse