Provider Demographics
NPI:1295268241
Name:HANSEN, CAMILLA CATHERINE KAREN (NP)
Entity type:Individual
Prefix:
First Name:CAMILLA
Middle Name:CATHERINE KAREN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5027 PENNELL RD
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-1869
Mailing Address - Country:US
Mailing Address - Phone:866-862-2955
Mailing Address - Fax:
Practice Address - Street 1:5027 PENNELL RD
Practice Address - Street 2:
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014-1869
Practice Address - Country:US
Practice Address - Phone:866-862-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP17088OtherSTATE LICENSE