Provider Demographics
NPI:1831390012
Name:HANSEN, CAROL ELIZABETH (RNC FNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ELIZABETH
Last Name:HANSEN
Suffix:
Gender:F
Credentials:RNC FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WAGON DR
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1678
Mailing Address - Country:US
Mailing Address - Phone:413-599-1356
Mailing Address - Fax:
Practice Address - Street 1:80 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3564
Practice Address - Country:US
Practice Address - Phone:413-732-0040
Practice Address - Fax:413-732-7007
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA126357363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110089946AMedicaid