Provider Demographics
NPI:1851365563
Name:HANSON, LINDA R (CNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:HANSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:R
Other - Last Name:GUNDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:5000 S MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2707
Mailing Address - Country:US
Mailing Address - Phone:605-371-6899
Mailing Address - Fax:877-215-2301
Practice Address - Street 1:5000 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2707
Practice Address - Country:US
Practice Address - Phone:605-371-6899
Practice Address - Fax:877-215-2301
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD199929112163WW0000X
SDCNPCP000386363L00000X
SDR026343363L00000X
MNR1401378363L00000X
IAA098703363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS41574Medicare PIN
Q05270Medicare UPIN
SDQ05270Medicare UPIN