Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 57209-20 | WI |
N | 207RI0011X | Interventional Cardiology | 57209-20 | WI |
NPI | 1114128048 |
---|---|
Provider Name | Dr. James Christopher Hansen |
First Address | Green Bay, WI 54307-9070 |
Second Address | Green Bay, WI 54303-3268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 12/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
57209-20 | WI LIC (01) | WI |