Provider Demographics
NPI:1801595905
Name:HANSON, IRENE JOY (APRN, CNP)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:JOY
Last Name:HANSON
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2162 JADE LN NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-5416
Mailing Address - Country:US
Mailing Address - Phone:507-272-1209
Mailing Address - Fax:
Practice Address - Street 1:102 ELTON HILLS DR NW STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3564
Practice Address - Country:US
Practice Address - Phone:507-280-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9981363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily