Healthcare Provider Details

I. General information

NPI: 1215882576
Provider Name (Legal Business Name): AUSTIN RAY HANSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S BRUCE ST
MARSHALL MN
56258-1934
US

IV. Provider business mailing address

810 DESCHEPPER ST
MARSHALL MN
56258-3742
US

V. Phone/Fax

Practice location:
  • Phone: 507-532-9661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3344
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2464878
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: