Provider Demographics
NPI:1184925810
Name:HANSON, MICHELE (APRN- CNP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:APRN- CNP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1323 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-6714
Mailing Address - Country:US
Mailing Address - Phone:937-586-9733
Mailing Address - Fax:
Practice Address - Street 1:5 ALEXANDERSVILLE RD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3672
Practice Address - Country:US
Practice Address - Phone:937-247-0304
Practice Address - Fax:937-247-0313
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.01671363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3127780Medicaid