=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427116052
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BLAINETTE U. HANSON MPH,MSN,APRN-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 N. BAKER ST.
-----------------------------------------------------
City | ELLENTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-324-2845
-----------------------------------------------------
Fax | 229-324-3383
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6689 NEW RD
-----------------------------------------------------
City | HAHIRA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31632-4311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-794-3196
-----------------------------------------------------
Fax | 229-794-3928
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN096693
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------