Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | R194179-9 | MN |
NPI | 1124457486 |
---|---|
Provider Name | Hayley Hansen |
First Address | Duluth, MN 55805-1950 |
Second Address | Duluth, MN 55805-1950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2013 |
Last Update Date | 07/11/2013 |