Provider Demographics
NPI:1801852173
Name:HANSON, TIMOTHY A (CRNA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:HANSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6237 SW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4213
Mailing Address - Country:US
Mailing Address - Phone:785-271-1912
Mailing Address - Fax:785-271-1912
Practice Address - Street 1:215 N KANSAS ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-5443
Practice Address - Country:US
Practice Address - Phone:580-772-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55082367500000X
OKR0087708367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS144821Medicare ID - Type Unspecified