Provider Demographics
NPI:1457598229
Name:HANSON, MICHAEL KEITH JR (RN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KEITH
Last Name:HANSON
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1080 ARBORWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-2564
Mailing Address - Country:US
Mailing Address - Phone:937-217-9330
Mailing Address - Fax:
Practice Address - Street 1:1325 E KEMPER RD STE 200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3946
Practice Address - Country:US
Practice Address - Phone:937-217-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.409709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0012541Medicaid