Healthcare Provider Details

I. General information

NPI: 1407093255
Provider Name (Legal Business Name): RONALD E HANSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 SAINT ANDREW ST STE 100
LA CROSSE WI
54603-3301
US

IV. Provider business mailing address

W12444 IVERSON RD
WHITEHALL WI
54773-8907
US

V. Phone/Fax

Practice location:
  • Phone: 608-989-2745
  • Fax:
Mailing address:
  • Phone: 715-983-2143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number73950-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: