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NPI Code Detail

MEDICARE: DR. GINA CORRELL HANSEN DO

MEDICARE: DR. GINA CORRELL HANSEN DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician336799NY

General Provider Information

NPI Number : 1770220808
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GINA CORRELL HANSEN DO
Provider Business Mailing Address
First Line : 85 S WEST ST
Second Line :
City : HOMER
State : NY
Zip : 13077-1542
Country : US
Telephone Number : 607-753-3774
Fax Number :
Provider Business Practice Location Address
First Line : 3 TECHNOLOGY PL
Second Line :
City : HOMER
State : NY
Zip : 13077-1526
Country : US
Telephone Number : 607-753-3774
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2022
Last Update Date : 07/29/2025

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