Provider Demographics
NPI:1952039380
Name:HANSEN, AMANDA MEGAN (APN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MEGAN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 ROUTE 28 STE 2100
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-1363
Mailing Address - Country:US
Mailing Address - Phone:908-725-5530
Mailing Address - Fax:908-253-6559
Practice Address - Street 1:575 ROUTE 28 STE 2100
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1363
Practice Address - Country:US
Practice Address - Phone:908-725-5530
Practice Address - Fax:908-253-6559
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01350600363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics