MEDICARE: MR. DAVID K. HANSEN CRNA

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
1	367500000X	Certified Registered Nurse Anesthetist	209-000385	IL

General Provider Information

NPI Number	:	1558303669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID K. HANSEN CRNA

Provider Business Mailing Address
First Line	:	4309 W MEDICAL CENTER DR
Second Line	:	SUITE A201
City	:	MCHENRY
State	:	IL
Zip	:	60050-8419
Country	:	US
Telephone Number	:	815-385-0084
Fax Number	:	815-385-8968

Provider Business Practice Location Address
First Line	:	4309 W MEDICAL CENTER DR
Second Line	:	SUITE A201
City	:	MCHENRY
State	:	IL
Zip	:	60050-8419
Country	:	US
Telephone Number	:	815-385-0084
Fax Number	:	815-385-8968

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/05/2012

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