Provider Demographics
NPI:1184100984
Name:HANSEN, DONALD JOSEPH (AMCA-4709)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:JOSEPH
Last Name:HANSEN
Suffix:
Gender:M
Credentials:AMCA-4709
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 SPRUCE RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2504
Mailing Address - Country:US
Mailing Address - Phone:630-880-9543
Mailing Address - Fax:630-596-1404
Practice Address - Street 1:541 SPRUCE RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2504
Practice Address - Country:US
Practice Address - Phone:630-880-9543
Practice Address - Fax:630-596-1404
Is Sole Proprietor?:No
Enumeration Date:2018-07-14
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILAMCA-4709246RP1900X
247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy