Provider Demographics
NPI:1831193374
Name:HANSEN, MELINDA C (MD)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:C
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12339 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8148
Mailing Address - Country:US
Mailing Address - Phone:515-263-9107
Mailing Address - Fax:515-265-9888
Practice Address - Street 1:12339 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8148
Practice Address - Country:US
Practice Address - Phone:515-263-9107
Practice Address - Fax:515-265-9888
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35284207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA09741OtherWELLMARK, ANKENY OFFICE
IA0415570Medicaid
IA35887OtherWELLMARK BLUE SHIELD
IA0415570Medicaid
IA35887OtherWELLMARK BLUE SHIELD