Provider Demographics
NPI:1851798656
Name:HANSEN, CRAIG SCOTT
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:SCOTT
Last Name:HANSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4956 CHERRYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1403
Mailing Address - Country:US
Mailing Address - Phone:218-590-8401
Mailing Address - Fax:
Practice Address - Street 1:4956 CHERRYWOOD LN
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-1403
Practice Address - Country:US
Practice Address - Phone:218-590-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide