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NPI Code Detail

MEDICARE: LISA HANSEN

MEDICARE: LISA HANSEN
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
1183500000XPharmacist123937MN

General Provider Information

NPI Number : 1396365649
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA HANSEN
Provider Business Mailing Address
First Line : 4656 EXCELSIOR BLVD
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55416-4938
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4656 EXCELSIOR BLVD
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55416-4938
Country : US
Telephone Number : 952-929-0140
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2020
Last Update Date : 04/16/2020

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Directions to “ LISA HANSEN ” Practice Location

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