Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | R1402513 | MN |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R1402513 | MN |
NPI | 1023074655 |
---|---|
Provider Name | Gretchen L Hanson |
First Address | Roseville, MN 55113 |
Second Address | Maplewood, MN 55109-1126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2006 |
Last Update Date | 20/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
305435700 | (05) | MN |