Provider Demographics
NPI:1457395089
Name:HANSON, JONATHAN (FNP)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:HANSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6906
Mailing Address - Country:US
Mailing Address - Phone:540-662-1108
Mailing Address - Fax:
Practice Address - Street 1:400 CAMPUS BLVD.
Practice Address - Street 2:SUITE 100
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6906
Practice Address - Country:US
Practice Address - Phone:540-662-1108
Practice Address - Fax:540-450-2244
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP95829Medicare UPIN
VA002464S14Medicare ID - Type UnspecifiedMEDICARE OF VA