MEDICARE: MELINDA C HANSEN MD

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	207V00000X	Obstetrics & Gynecology Physician	35284	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09741	OTHER	IA	WELLMARK, ANKENY OFFICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	35887	OTHER	IA	WELLMARK BLUE SHIELD

General Provider Information

NPI Number	:	1831193374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA C HANSEN MD

Provider Business Mailing Address
First Line	:	12339 STRATFORD DR
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-8148
Country	:	US
Telephone Number	:	515-263-9107
Fax Number	:	515-265-9888

Provider Business Practice Location Address
First Line	:	12339 STRATFORD DR
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-8148
Country	:	US
Telephone Number	:	515-263-9107
Fax Number	:	515-265-9888

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	10/31/2007

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Directions to “ MELINDA C HANSEN MD” Practice Location

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