Provider Demographics
NPI:1922670702
Name:HANSON, JENNIFER (MD, RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:MD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 N SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-4737
Mailing Address - Country:US
Mailing Address - Phone:920-441-2032
Mailing Address - Fax:
Practice Address - Street 1:414 DOCTORS CT
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2065
Practice Address - Country:US
Practice Address - Phone:920-509-5597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program