Provider Demographics
NPI:1659108090
Name:HANSON, TERESA (DNP, PMHNP)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-4644
Mailing Address - Country:US
Mailing Address - Phone:319-433-1445
Mailing Address - Fax:
Practice Address - Street 1:501 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-4644
Practice Address - Country:US
Practice Address - Phone:319-433-1445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG179174363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health