Provider Demographics
NPI:1861020018
Name:HANSON, JANICE ANN
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:ANN
Last Name:HANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 PEBBLE BEACH RD
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-7585
Mailing Address - Country:US
Mailing Address - Phone:563-380-8186
Mailing Address - Fax:
Practice Address - Street 1:1798 OLD STAGE RD
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-7497
Practice Address - Country:US
Practice Address - Phone:563-382-8456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist