Provider Demographics
NPI:1184715195
Name:HANSON, ELISA V (FNP-BC)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:V
Last Name:HANSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 NEAL ST STE 300
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-4234
Mailing Address - Country:US
Mailing Address - Phone:612-206-0924
Mailing Address - Fax:763-231-8711
Practice Address - Street 1:2040 NEAL ST STE 300
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-4234
Practice Address - Country:US
Practice Address - Phone:612-206-0924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND711549Medicare PIN
Q11279Medicare UPIN