Provider Demographics
NPI:1720560089
Name:HANSEN, TRACY LYNN (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 151ST ST
Mailing Address - Street 2:
Mailing Address - City:CURRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56123-1025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2040 JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:SLAYTON
Practice Address - State:MN
Practice Address - Zip Code:56172-1017
Practice Address - Country:US
Practice Address - Phone:507-836-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily