Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 55607 | MN |
NPI | 1023337946 |
---|---|
Provider Name | Dr. Holly Christine Hanson |
First Address | Eden Prairie, MN 55347 |
Second Address | Eden Prairie, MN 55347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2010 |
Last Update Date | 21/03/2018 |