Provider Demographics
NPI:1336431543
Name:HANSEN, DRUSCELLA CORRINA
Entity Type:Individual
Prefix:MRS
First Name:DRUSCELLA
Middle Name:CORRINA
Last Name:HANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 DONALD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112
Mailing Address - Country:US
Mailing Address - Phone:318-272-8238
Mailing Address - Fax:
Practice Address - Street 1:1144 WALLER AVENUE
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112
Practice Address - Country:US
Practice Address - Phone:318-746-8729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA447307938AMedicare UPIN