Healthcare Provider Details

I. General information

NPI: 1952662694
Provider Name (Legal Business Name): JESSICA LIN HANSEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA LIN OLSON

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 YANKEE DOODLE RD
EAGAN MN
55121-2092
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 651-454-3970
  • Fax: 651-241-0059
Mailing address:
  • Phone: 612-262-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number108228
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: