Provider Demographics
NPI:1982220265
Name:HANSEN, JONATHON WILLIAM (RN)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:WILLIAM
Last Name:HANSEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7060 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-9693
Mailing Address - Country:US
Mailing Address - Phone:320-828-7310
Mailing Address - Fax:715-274-2702
Practice Address - Street 1:450 LAKE DR
Practice Address - Street 2:
Practice Address - City:MELLEN
Practice Address - State:WI
Practice Address - Zip Code:54546-9750
Practice Address - Country:US
Practice Address - Phone:715-274-5706
Practice Address - Fax:715-274-2702
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2423148163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse