Individual
SUSAN JANELLE HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1707 GOLD DR, FARGO, ND 58103-6413
(701) 280-2033
(701) 232-5578
Mailing address
4450 31ST AVE S, STE 102, FARGO, ND 58104-4557
(701) 280-2033
(701) 232-5578
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PAC0312
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-19213
MEDICA
—
05
—
11277
—
ND
01
—
2303752
AMERICAS PPO
—
01
—
24823
ND BLUE SHIELD
ND
01
—
HN10910428
PREFERRED ONE
—
01
—
P50714
HEALTH PARTNERS
—
01
—
Q25266
ND WORKERS COMP
ND
Enumeration date
06/06/2006
Last updated
04/05/2019
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