Provider Demographics
NPI:1023105467
Name:HANSON, NICOLE ANNA (MS PA-C)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANNA
Last Name:HANSON
Suffix:
Gender:F
Credentials:MS PA-C
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:ANNA
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS PA-C
Mailing Address - Street 1:PO BOX 14017
Mailing Address - Street 2:1617 SHERMAN AVENUE
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53708-0017
Mailing Address - Country:US
Mailing Address - Phone:608-240-0020
Mailing Address - Fax:608-245-3879
Practice Address - Street 1:1617 SHERMAN AVENUE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53708-0017
Practice Address - Country:US
Practice Address - Phone:608-240-0020
Practice Address - Fax:608-245-3879
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1800 - 023363AM0700X
NVPA1353363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
K400219987Medicare PIN