Provider Demographics
NPI:1861824948
Name:HANSEN, NICOLE E (APNP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:E
Last Name:HANSEN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:E
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:725 S WEBSTER AVE
Practice Address - Street 2:THE NEURO TEAM
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3500
Practice Address - Country:US
Practice Address - Phone:920-433-7995
Practice Address - Fax:920-433-3458
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5362-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2013009391OtherAMERICAN NURSES CREDENTIALING CENTER