Provider Demographics
NPI:1457905705
Name:HANSEN, STEPHANIE MONIQUE (FNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MONIQUE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MONIQUE
Other - Last Name:ASHBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:813 30TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-3603
Mailing Address - Country:US
Mailing Address - Phone:319-371-9775
Mailing Address - Fax:
Practice Address - Street 1:1307 S GEAR AVE
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1604
Practice Address - Country:US
Practice Address - Phone:319-768-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA156211363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner