Provider Demographics
NPI:1770220808
Name:CORRELL HANSEN, GINA (DO)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:CORRELL HANSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:CORRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:85 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1542
Mailing Address - Country:US
Mailing Address - Phone:607-753-3774
Mailing Address - Fax:
Practice Address - Street 1:3 TECHNOLOGY PL
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077-1526
Practice Address - Country:US
Practice Address - Phone:607-753-3774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336799207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine