Provider Demographics
NPI:1396765772
Name:HANSEN, MARILYN R (CNP)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:R
Last Name:HANSEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 RICHMOND RD
Mailing Address - Street 2:CENTER FOR SKILLED NURSING CARE
Mailing Address - City:HIGHLAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6106
Mailing Address - Country:US
Mailing Address - Phone:216-464-9500
Mailing Address - Fax:
Practice Address - Street 1:4310 RICHMOND RD
Practice Address - Street 2:CENTER FOR SKILLED NURSING CARE
Practice Address - City:HIGHLAND HILLS
Practice Address - State:OH
Practice Address - Zip Code:44122-6106
Practice Address - Country:US
Practice Address - Phone:216-464-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP02348363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2067409Medicaid
OHS62103Medicare UPIN
OHHANP75411Medicare ID - Type Unspecified